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The Risks and Benefits of Fluoride in Drinking Water McKeveny
Fiona McKeveny
18 December 2018
“There are no secrets to success. It is the result of preparation, hard work, and learning from
failure.”
- Colin Powell
As this semester comes to an end, and as I approach the end of my writing experience for
this class, I can reflect back and say I am proud of what I have accomplished. The research I
have done, the facts I have gathered, and the paper I have written really allowed me to gain a
great learning experience. This research and writing experience, I realized, can go far beyond
just this class. The skill set I gained throughout the course of this semester can be applied when I
am working in any field or on any project. This experience has taught me that in order to be
successful and have a final product worth reading, perseverance and learning from times of
failure or frustration must be had. As I have seen my work and research from the entire semester
finally come together, I feel a great sense of accomplishment.
“Research is to see what everybody else has seen, and to think what nobody else has thought.”
- Albert Szent-Gyorgyi
This quote by Gyorgyi relates to not only classes of a scientific disciple, but to all
academic disciplines and to all ways of thinking. Without proper research, there is no way to
fully understand or comprehend a certain issue at hand. Finding a topic of interest, looking into
that topic, asking questions, obtaining the answers to those questions, and developing a unique
way of thinking about the information and issue that nobody else has is perhaps the greatest
learning opportunity one can experience.
The Risks and Benefits of Fluoride in Drinking Water McKeveny
My name is Fiona McKeveny. I grew up and still live in Staten Island, NY. I attended
Wagner College, which is also located in Staten Island, where I completed my undergraduate
degree. I graduated from Wagner with my B.S. in Chemistry and Biology minor in 2017. I am
now in my second year of studying dental hygiene at NYU. I am currently enrolled in the 3-year
AAS Dental Hygiene program. I decided to do the 3-year program as opposed to the 2-year
program due to the fact that it involves a lighter schedule load, which allows me to work more. I
have been working at a private practice orthodontic office for the past 2 years. At my job I
mainly do infection control, as well as work alongside the doctor to help assist with suctioning,
completing orthodontic photos and x-rays, and giving instructions and guidance to the patients
on how to properly care for their braces and oral health.
Since I have been involved in the dental field for the past 2 years, and because I am
pursuing a degree in dental hygiene, I felt that the topic of whether or not fluoride in drinking
water is safe for people from different regions would be an interesting, yet challenging one for
me to explore and analyze. The reason why I feel that this topic may be a challenge for me,
personally, is because in the dental field fluoride is very commonly used as part of the patients’
treatments. However, because of my background in biology and chemistry, I feel that there are
precautions that should be taken when using fluoride for patient care because of the fact that
there are studies that discuss how fluoride, especially the fluoride that is found in drinking water,
may have potential risks to people who are exposed to high levels of it. I am going to explore
this controversial question to see if there is a potential risk in high levels of fluoride in drinking
water, and if risks are being found, is it then safe to be using fluoride as a treatment for patients
teeth. In developing regions of the world, such as certain areas of Bangladesh and India, the
levels of fluoride in the drinking water are higher than what is regulated by the World Health
The Risks and Benefits of Fluoride in Drinking Water McKeveny
Organization. In more advanced regions, such as New York, the levels of fluoride added to the
drinking water is regulated by the WHO. However, it may still not be safe to intake so much of it
being that one can get the accurate amount of fluoride intake through treatment from their
dentist, as well as from toothpastes and mouthwashes that have fluoride in them. The reason why
fluoride is used on patients in dental practices and why it is added to drinking water is because it
is believed to help protect the teeth and to prevent tooth decay. However, this practice of adding
fluoride to drinking water as a method to help prevent tooth decay has remained a controversial
topic since 1945.
One quote that stood out to me in Paul Kalanithi’s “When Breath Becomes Air” was
“Human knowledge is never contained in one person. It grows from the relationships we create
between each other and the world, and still it is never complete.” I believe this quote can apply to
any area of study or examination for any discipline. I feel that this quote is important to look
towards and take into consideration when evaluating and determining a solution to a problem,
because it always seems that the information and knowledge we gain as a population and as a
community is not due to one person, one scientist, or one health care professional; but rather is a
collective effort of all people working together to solve a common problem. And even then, a
definite solution to some problems cannot be solved. With my investigation of whether or not
this practice of adding fluoride to drinking water and the practice of using fluoride on patients to
prevent certain dental complications from happening, I do not plan on coming up with a solution
that would solve a controversial topic and problem that has been ongoing many decades, but
rather look at the information available on this topic, and then come up with my own theories
and hypotheses of what may come in the future if we continue to implement these practices and
maybe think of another possible solution that can be implemented to begin to fix these issues.
The Risks and Benefits of Fluoride in Drinking Water McKeveny
“Treat the Earth and all that dwell thereon with respect
Remain close to the Great Spirit
Show great respect for your fellow beings
Work together for the benefit of all humankind
Give assistance and kindness wherever needed
Do what you know to be right
Look after the well-being of mind and body
Dedicate a share of your efforts to the greater good
Be truthful and honest at all times
Take full responsibility for your actions”
- Ten Commandments II
I find this second part of the Native American Ten Commandments to be strongly
correlated to many issues that we find prevalent in today’s world. The problems and attention
that this literary work brings forth are of great importance, and when fully analyzed, can be very
mind-opening when looked at alongside an actual issue that needs to be solved. One very
controversial issue in our world today is whether or not the practice of adding fluoride to
drinking water in certain regions is safe. The reason why this is so controversial is because in
certain regions of Bangladesh and neighboring areas of India, groundwater that contains
elements, such as arsenic and fluoride presents serious issues for the people and environment.
This is a recent issue specifically in the Eastern Regions of Bangladesh, since this area has been
The Risks and Benefits of Fluoride in Drinking Water McKeveny
having much fluoride contamination and has had fluorosis effects on many people living in this
region. If the elements of arsenic and fluoride are causing harm in developing regions of the
world, then why does the World Health Organization allow the addition of certain elements into
the drinking water of other regions, for example the addition of fluoride in New York drinking
water. This poetic work will be a great source to refer back to when trying to analyze, research,
and determine possible solutions to this problem, due to the fact that there is a positive message
and a common goal that is being communicated.
The reason I am so passionate about this topic is due to two main reasons. One reason is
because I am pursuing a career in dental hygiene, and since I will be practicing as a licensed
clinician in the dental field in a few short years, I would like to educate myself as fully as
possible on the risks of using fluoride. Although I am now in classes, such as clinic, that
explicitly educates me on various procedures, techniques, and materials that I will be using in
this field, I also like to further educate myself by doing my own studying and research when
certain topics spark my interest. I developed this method of studying through further research
back in my undergrad, and have continued to stick with it because I feel that I am providing
myself with a deeper understanding. I would like to fully know, especially when being a health
care provider to others in the future, what risks I may be exposing a patient to, aside from certain
risks that are already accounted for as norms in this field. The other reason that I feel especially
passionate about this topic is because towards the end of my senior year as an undergraduate
student, I helped one of my professors do some research and study the fluoride in groundwater in
different regions of the world. My professor, Dr. Alauddin, really helped me to gain a deep
understanding of chemistry from a research standpoint. Dr. Alauddin is originally from
Bangladesh, and some of his family still lives there. I had the pleasure of meeting his daughter
The Risks and Benefits of Fluoride in Drinking Water McKeveny
who was also born there. He was personally affected by the findings in some of our research due
to the fact that some of his friends and family live there. When he asked for me to be a part of
this project, I was instantly eager to begin. This was not only one of the first opportunities I had
to do research with real life, attainable data, but one that I felt good about doing because the
information and data attained would be used to solve real life worldly problems. Although I
helped to analyze water samples taken from these regions, and assisted in computing and
determining results, I was not able to fully look into these results on a larger scale and infer how
serious this issue was, how the people in those regions were affected, and possible solutions that
could be offered to help since I graduated before any more research and problem solving could
be achieved on my end.
I am taking my interest and passion for dental hygiene and integrating it with my
chemistry and biochemistry background to analyze the problems and risks fluoride presents to
those exposed to it. I plan to research why groundwater in different regions have higher levels of
fluoride, to determine if fluoride is safe to be added to drinking water in more advanced regions,
such as New York, and to deduce if it can pose a potential risk by being utilized in the dental
field.
The issue of whether or not fluoride provides a huge risk to those who intake this element
has been a very controversial topic since 1945. The first occurence of adding fluoride to drinking
water was done in 1945 in the Grand Rapids, Michigan. The idea behind adding fluoride to
drinking water is because fluoride is believed to prevent cavities and dental diseases. “Some
claim it does little or nothing to prevent tooth decay and is dangerous for health. Others,
including most dentists and public health officials, say it significantly lowers rates of tooth decay
and presents no important health risks.” (Hileman, 2006) Although this topic of dispute has been
The Risks and Benefits of Fluoride in Drinking Water McKeveny
a prevalent one for the past 70 plus years, there is still not that much research being done, tests
being ran, and samples being pulled from various regions to determine exactly how serious and
dangerous some fluoride levels can be. The main reason why this topic is one that is constantly
up for dispute is because many people do not understand the information, facts, and research that
has been done on fluoride. Many times people believe sources that are not always credible and
misinterpret what they read and hear about this subject. According to the National Center for
Biotechnology Information “Problems include identifying benefits and harms, whether fluoride
is a medicine, and the ethical implications.” (Cheng, 2007)
I think that if we as a society, and even myself when I become a licensed healthcare
provider, better educate the public about fluoride, its advantages and disadvantages, its risks and
benefits, then there would be less dispute and more of a complete understanding. In light of the
poetic work “Ten Commandments II”, a point that seems to be frequently stressed is the idea that
we should all hold in high regards the well-being and benefit of humankind and do what is best
for the greater good. The question of “Is it right that this practice of adding fluoride to drinking
water should be done when the public has not given consent and do not have a say whether or
not they want to intake this element?” is one that is the most debatable and frequently asked,
however is yet to be resolved. The reason why this question, specifically, brings forth much
controversy is because many people believe that this practice of adding fluoride without their
consent is not only unfair, but is unethical and wrong. Many people believe this practice is not
beneficial and is not done with the greater good of people in mind. Through further extensive
research that is to follow, I will be attempting to provide an answer to this question and a
solution to this problem as a whole.
The Risks and Benefits of Fluoride in Drinking Water McKeveny
“Science is a way of life. Science is a perspective. Science is the process that takes us from
confusion to understanding in a manner that's precise, predictive and reliable - a
transformation, for those lucky enough to experience it, that is empowering and emotional.”
- Brian Greene
There is no way to establish a solution to a given problem without proper understanding
of the issue at hand and without appropriate information and research to resolve said issue. By
implementing research, tests and results, and analysis of the results; a solution to the issue of
fluoridation of groundwater can potentially be solved in the future. Through my own personal
research, I found that by examining water samples that were taken from Bangladesh to be a very
helpful, insightful, and crucial aspect when analyzing and examining the issue of how high levels
of fluoride in groundwater can cause serious health calamity. Although I am from New York and
have been living, working, and going to school in New York my whole life, I think that in order
to have an open mind and to understand how other people live it is important to look at problems
and issues we are having, from their point of view. I feel it is important to compare and contrast
similar issues or problems of the same subject in order to gain a broader view and a greater
knowledge of the situation. By looking at Bangladesh, and then comparing their issues of
fluoride in the groundwater and then comparing it to New York’s levels of fluoride and the
fluoride that is used in dentistry, I believe that an even greater understanding can be achieved, as
well as a solution that can hopefully be implemented for all people to overcome this dilemma.
In my research, I investigated why certain regions of Bangladesh were particularly being
contaminated by fluoride. Although the levels of fluoride were in question and what I was
testing, I had to first compare fluoride to another element that seemed to have caused issues and
The Risks and Benefits of Fluoride in Drinking Water McKeveny
health calamity as well, in order to have an idea of what the ratio of fluoride to that of other
elements was. In order to determine how serious and high the concentration of fluoride was in
the groundwater, I compared the element of fluoride to arsenic, since there were high levels of
arsenic found in the same regions and groundwater. The groundwater in these regions of
Bangladesh, which contain high levels of arsenic and fluoride, presents serious issues and health
calamity.
Much of the groundwater in Bangladesh is known to contain high levels of arsenic.
Excessive arsenic intake can lead to arsenicosis, hyperkeratosis, and cancer. (WHO) The main
levels that are most affected by high arsenic levels in the groundwater are the flood plains, table
lands, and deltas. However, this problem has been going on for years, and there have been many
studies done on this particular issue and solutions to this problem are still in progress. In recent
times, another issue has come forth concerning a different region of Bangladesh, which are the
hill tracts. These hill tracts have not been affected by high arsenic levels, however it has been
discovered that there are high levels of fluoride.
In Bangladesh, there are three main geomorphological regions that have especially been
affected by arsenic contamination in the groundwater; which are flood plains, table lands, and
deltas. These three regions, as well as the hill tracts, compose Bangladesh. It is considered that
the flood plains and table lands, which contain Holocene sediments, are rich in arsenic bearing
minerals. However, the hill tracts, which contain Pliocene sandstone, are not rich in arsenic
bearing minerals and is mostly free from arsenic. Although these hill tracts are generally free
from arsenic, one of my recent studies, alongside Dr. Alauddin, which included an analysis of
approximately 150 groundwater samples from hill tracts areas, indicated that 20% of the samples
possess fluoride levels that are greater than the World Health Organization regulated value.
The Risks and Benefits of Fluoride in Drinking Water McKeveny
These hill tracts are the only areas that are identified to have significant levels of fluoride in the
groundwater. Whether or not the fluoride levels in groundwater can be the cause of a potential
public health issue in Bangladesh is still in question. However, the recent findings suggest a
strict monitoring of fluoride, as well as other ions in groundwater in Bangladesh, be initiated.
(Alauddin, 2016)
The main source of high fluoride intake for humans is through the drinking water,
specifically in regions of the world where fluoride concentrations in groundwater and surface-
water are high. “It is estimated that more than 200 million people worldwide rely on drinking
water with fluoride concentrations that exceed the present WHO guideline of 1.5 mg L−1.”
(Manouchehr, 2008) The practice of adding fluoride to drinking water sources in order to help
prevent tooth decay has remained a controversial topic since 1945. (Hileman, 2006) Due to
potential health risks that high fluoride (F-) intake levels can cause, the World Health
Organization (WHO) set a guideline permissible value of fluoride to not exceed 1.0 ppm.
In order to test the Chittagong Hill Tracts in Bangladesh for F- levels in the ground,
surface water levels, and to compare F- with other ions found in this groundwater, 300 samples
first had to be collected in Bangladesh, where they were then transported to the lab at Wagner
College. The way these samples were analyzed was through the analytical technique of Ion
Chromatography (IC). Ion chromatography is a form of liquid chromatography that is utilized to
separate different ions based on their charge. This technique isolates all ions that are present in a
certain sample so that each ion and element can be studied and analyzed. This technique is
especially beneficial and useful when measuring the concentration of a particular ion in a water
sample. Ion chromatography allowed for the most accurate screening the fluoride levels present
in these 300 groundwater samples.
The Risks and Benefits of Fluoride in Drinking Water McKeveny
This analysis was done by taking a small volume of each sample, which is referred to as
the mobile phase, and pumping the sample through a column of packed particles, which is
referred to as the stationary phase. The time it takes for the ion to pass through is recorded and
this is known as the retention time. The retention time of the ion depends on how it interacts with
the column both physically and chemically. Once the samples were run through the Ion
Chromatograph machine, the peaks of each ion were shown. A direct correlation can be seen
between the concentrations of the ions moving through the column at a particular time and the
concentration of a particular species in the sample solution. Once this was done the data on F-
was compared to each of the other ions found in these water samples in order to see if there was
any correlation. This was done so that the source of the high fluoride levels in the Chittagong
Hill Tract region of Bangladesh could be determined.
At the completion of this analysis and experiment, it was able to be concluded that there
was no correlation between these elements which meant other bodies of water did not
contaminate these bodies of water in Chittagong Hill Tracts. Due to the fact that there was no
correlation between fluoride and the other ions, as seen by the low R-values, it can be concluded
that there was no contamination between the seawater and the groundwater in Bangladesh.
Since the high fluoride levels in the Chittagong Hill Tracts groundwater was not from an
insurgence of water, this suggests that the sediments in the ground themselves leach out these
ions, causing the fluoride levels to rise. With the exception of a few samples, the fluoride levels
in most of the samples taken were within the WHO permissible guidelines, which is less than
1.0 ppm. Although high fluoride levels in groundwater is not ideal, it is not seen as a serious
issue as of yet. However, some specific areas in developing countries, especially Bangladesh,
need to be closely monitored in the coming years for a potential high level of fluoride. In the
The Risks and Benefits of Fluoride in Drinking Water McKeveny
future, more work needs to be done in order to identify the minerals that release the fluoride, thus
causing higher and more dangerous levels of fluoride to be in the ground and surface water. Also
the possible cause of the release of this fluoride needs to be studied within the coming years in
order to be more able to prevent this from happening.
The question now remains, how can we prevent consuming excess fluoride water from
groundwater in order to avoid future health calamity and is there a way people from various
regions around the world can obtain the benefits while still avoiding the risks and dangers of this
element?
“Health is not valued till sickness comes”
- Thomas Fuller
The consumption of fluoride by all people, especially the people who populate the
Eastern regions of Bangladesh, is a more serious health calamity than most realize. The focus of
the people in the Eastern regions of Bangladesh is important to study due to the fact that the
levels of fluoride found in this area exceed the level that the World Health Organization allows
in other regions of the world, New York to be specific. Although the levels of fluoride being
added to New York water is monitored, any intake of fluoride can potentially cause critical
health risks. Without educating oneself on the harms of fluoride intake, there is no way to
prevent the illnesses and diseases that correlate to the consumption of this element.
Intaking high levels and large amounts of fluoride by way of drinking water can cause
many different health problems. The ingestion of this element can cause a problem known as
fluorosis, which impinges the health of the teeth and bones in the body. According to the World
The Risks and Benefits of Fluoride in Drinking Water McKeveny
Health Organization “Moderate amounts lead to dental effects, but long-term ingestion of large
amounts can lead to potentially severe skeletal problems.” (WHO, 2018) Although fluorosis of
the teeth and bones are the most frequently seen health problems that are caused by high fluoride
intakes, there are a list of other health concerns that is caused by fluoride intake, including cancer
and human intelligence.
Due to the fact that the element of fluoride is prevalently known and associated with use
in the dental field, one of the most commonly seen health problems due to high fluoride intake is
dental fluorosis. Dental fluorosis is a defect in the enamel of the tooth due to extreme fluoride
intake, especially in the early development phases of enamel formation. The one major sign that
someone is suffering with dental fluorosis is the enamel of that person’s teeth are typically
marked with void spaces, or noticeable elevated porosity. This defect in the enamel is a condition
that is referred to as hypomineralization. Essentially, the enamel of the tooth surface is
hypomineralized by the fluoride, thus weakening the teeth because this outer layer is slowly
being destroyed. “Although fluorosis can be cosmetically treated, the damage to the enamel is
permanent. Common causes of fluorosis include: fluoridated drinking water (particularly during
infancy), ingestion of fluoride toothpaste, use of fluoride tablets, and consumption of processed
foods made with fluoridated water.” (Fluoride Action Network)
Since the major source of fluoride consumption is drinking water, the Environmental
Protection Agency and World Health Organization must make sure all drinking water has a
fluoride level no higher than 2.0 ppm, otherwise known as parts per million. However, once the
fluoride concentration levels in drinking water is above 2.0 ppm, it becomes very difficult to
remedy and maintain this problem since it is extremely hard and unaffordable to remove excess
fluoride from drinking water. According to the World Health Organization “The preferred option
The Risks and Benefits of Fluoride in Drinking Water McKeveny
is to find a supply of safe drinking-water with safe fluoride levels.” (World Health Organization,
2018) It is also suggested by the American Dental Association “People living in areas where
naturally occurring fluoride levels in drinking water exceed 2 parts per million should consider
an alternative water source or home water treatments to reduce the risk of fluorosis for young
children.” (American Dental Association, 2018) Finding an alternate water source in order to
avoid dental fluorosis, and high fluoride intake of any kind, seems like a simple solution to this
problem, however it is not necessarily a realistic one for people living in various regions of the
world. In developing regions such as Bangladesh, the people living in this area do not have that
option. In poor areas, it is often the case that the only source of water comes directly from the
drinking, or groundwater, of that geomorphological region. This health problem particularly
affects babies and young children until the age of eight because during these stages the teeth and
enamel layers of the teeth are forming, so exposure to high levels and intake of fluoride can stunt
the correct development. This is why it is suggested for young children ages eight or younger to
only use a pea sized drop of toothpaste when brushing their teeth so that excessive fluoride is not
being applied to the teeth or being swallowed.
In addition to dental fluorosis, high fluoride levels and large fluoride intakes can also lead
to skeletal fluorosis, which is a serious disabling bone disease. Skeletal fluorosis is usually
caused by the ingestion of extremely large amounts and high levels of fluoride over a prolonged
period of time. Although these circumstances that one would have to be under in order to suffer
from this disease seem extreme, skeletal fluorosis is not rare and there are a great number of
individuals that have to live with this condition. At times it is very difficult to distinguish skeletal
fluorosis from other joint and bone diseases, which is why many believe that fluoride is not very
harmful and is not the direct cause of this disease. “One of the reasons doctors fail to detect
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skeletal fluorosis is because the symptoms and appearance of fluorosis can closely resemble
other, more commonly known, bone and joint diseases.” (Fluoride Action Network, 2018)
Other health concerns caused by high fluoride intakes cause a number of other serious health
concerns. Another health problem that can result from consuming large amounts and high levels
of fluoride are arthritic symptoms, such as joint pain, stiffness, and swelling, as well as fatigue.
Bone fracture may also result due to the fact that the higher dosage of fluoride in drinking water
and a large intake of this water can lead to greater chances of bone fracture. Other health
problems that can result are cancer and human intelligence, which is mainly specific to children
who are exposed to early fluoride toxicity. (Hoque, 2003) & (WHO)
“The only way to keep your health is to eat what you don't want, drink what you don't like, and
do what you'd rather not.”
- Mark Twain
Being in control of what one intakes into their own bodies is an extremely important
concept that is a huge establishing factor of one’s own health and well-being. A person’s overall
health is heavily dependent on what is being taken into the body. In order to maintain good
physical, as well as oral, health it is critical to not only eat and drink healthy, nutritious foods and
vitamins, but to also avoid all toxic chemicals, foods, drinks, and elements that can be a potential
detriment to our health. The main thought that the majority of people seem to have when trying
to live a healthy lifestyle is to exercise, watch your diet, and drink plenty of water. However,
depending on the water source that people have access to and utilize to stay hydrated, they can
actually be causing more harm to themselves than they might realize.
The Risks and Benefits of Fluoride in Drinking Water McKeveny
Due to the fact that in certain regions and cities of the world, New York to be specific,
have fluoride purposely added to the drinking water, people do not have a say in what they are
consuming when they intake tap water. According to a National Research Council “The major
sources of exposure to fluoride are drinking water, food, dental products, and pesticides. The
biggest contributor to exposure for most people in the United States is drinking water.” (National
Academies Press, 2006) Fluoride is an element that is constantly up for dispute since it has
potential health benefits, but also has many risk factors. The questions and concerns that pertain
to the practice of adding fluoride to drinking water is a serious and prevalent problem that we
deal with today in advanced places, such as New York, as well as developing regions, such as
Bangladesh. This topic is extremely controversial because there are so many different viewpoints
one may have about this issue. Some strongly believe that fluoride is beneficial to be consuming
and the practice of adding this element to drinking water should be continued. Others have very
strong views and arguments against this and believe that consuming fluoride can have precarious
effects on people. And some are even torn and do not know fully which side to stand on, which
can be due to the lack of knowledge and information they have on the issue.
One reason why this issue is so controversial is because in certain developing regions of
the world, Bangladesh to be specific, there are high levels of fluoride that is found in their
groundwater, which has been proven to cause serious health calamity on the people in that area.
However, in other, more advanced, regions of the world, for example, New York, the element of
fluoride is added to the drinking water. The question is, even though the levels of fluoride being
added are monitored by the WHO, is it safe to consume without putting ourselves at serious
health risks. In general, anyone who is exposed to high levels or intake large amounts of fluoride
put themselves at risk of being exposed to fluorosis, which is a severe condition caused by
The Risks and Benefits of Fluoride in Drinking Water McKeveny
excessive intake of fluorine compounds. What makes many people angry and upset is that if it is
known that this element causes serious health adversity in regions that cannot control these
levels, than why would the government purposely add this element to our drinking water?
Another reason why this issue is of great importance, yet of great dispute, is because
many people are not able to speak up about what they want and what they allow themselves to be
consuming. A huge problem is that many people are not completely educated on this topic, and
because of that do not realize how serious it can be. People should be informed and well aware
of exactly what it is that they are consuming, and should have a say in whether or not the
government continues this practice of adding fluoride to drinking water. Especially in developing
regions of the world, where the populations struggle with poverty and since they are not very
advanced with technology, medicine, and engineering, they do not even have their drinking
water checked or monitored by any organization. People that live in developing regions of the
world who do not have access to fresh, clean, unpolluted water, and do not have things such as
water bottles that you can easily access from a grocery store, are forced to drink their
groundwater. However the groundwater in certain areas can actually be considered as toxic, due
to the astronomically high levels of fluoride, as well as other elements, chemicals, and waste. Of
course, for people that live in the Eastern regions of Bangladesh, this issue is even more serious
and can be more detrimental than it is for the people living in regions of New York. Although
these two regions of the world differ greatly and are at very different advancing levels, the
people can all relate to this problem, and people from both regions can relate in the fact that they
do not have a say in whether or not they consume fluoride, and if so, how high of a level they
intake.
The Risks and Benefits of Fluoride in Drinking Water McKeveny
“The more specific we are, the more universal something can become. Life is in the details. If
you generalize, it doesn't resonate. The specificity of it is what resonates.”
- Jacqueline Woodson
This quote by Woodson can apply, not just to life as a whole, but to research, specifically.
When researching a particular subject, discipline, or issue it is important to have information and
facts to back up the claims one is making. One way to make research that is conducted on a
particular issue resonated and understood for many people is to make sure that the information
and facts included are specific. Without providing accurate and specific facts to your audience
about the research you are doing, the information can be misunderstood, as well as allow for
different interpretations of your research to be done by many. In my research up to this point I
was mainly focusing on the different regions where naturally occurring fluoride can cause
serious health problems and then examining whether or not fluoride is a safe element to be using
in the practice of dentistry. However, this week I now plan to look into the specific amount of
fluoride that can be consumed without causing harm to the patient.
As I have previously discussed, there are many disadvantages and health problems that
can be cause by having either too much or too little fluoride in one's system. However, in order
to gain the benefits from fluoride, there are certain amounts that must be taken into consideration
in the field and practice of dentistry when using fluoride as part of a patient’s treatment. In the
dental field there are two ways that fluoride can be administered to a patient: topically and
systemically. Topical fluoride is used to strengthen the teeth by remineralizing the enamel and
preventing decay. Topical fluoride can be delivered through the use of a variety of products,
including toothpastes, mouthrinses, gels, and professionally applied fluoride treatments by the
The Risks and Benefits of Fluoride in Drinking Water McKeveny
dental hygienist. Systemic fluoride helps to strengthen the teeth by being integrated in the
forming tooth structure through ingestion. Systemic fluoride can be delivered through water
fluoridation and dietary fluoride supplements, such as drops, lozenges, and tablets. (ADA, 2017)
Lack of fluoride could potentially cause health problems, however too much, as we
know, can also lead to serious health calamity and concerns, which is why it is important to
analyze and understand how much fluoride, specifically, should be used in the practice of
dentistry. It is crucial that dental health care providers allow their patients to know the exact
amount that will be used on them in the dental office, as well to inform their patients on how
much fluoridated products to be using for their at home dental care and maintenance.
The amount, or dose, of fluoride to be administered for each patient depends on two main
factors; the age of the patient and how high of a risk the patient is to developing caries. Each
patient has their own personal risks in terms of their oral health and developing dental caries.
Patients who have good oral health and are not considered by their dental health care provider to
be at high risk may not need a fluoride treatment and may just be advised to continue using
fluoridated toothpaste and mouthrinses at home. However, if a patient comes in that the dental
health care provider deems as high risk for dental caries, they might administer a professional
fluoride treatment, as well as at home fluoride treatments and continuation of using fluoridated
toothpastes and mouthrinses. Some patients have conditions, such as xerostomia, otherwise
known as dry mouth, or other physical impairments that would make it difficult for said patient
to keep up with good oral hygiene care. (AAPD, 2018)
Age is perhaps the most important factor to consider when administering a patient with a
fluoride treatment of any kind, especially a child. Fluoride that is delivered topically is not
intended to be swallowed due to the fact that is is a treatment solely meant to strengthen the
The Risks and Benefits of Fluoride in Drinking Water McKeveny
teeth. When excess fluoride from these topical treatments is accidentally swallowed, slight cases
of fluorosis can occur. Since children have the tendency to accidentally swallow toothpaste,
mouthrinse, and fluoride treatment gels a lower dosage is recommended. Below is a chart
provided by the American Dental Association and the American Academy of Pediatrics which
shows the recommended fluoride supplement dose for patients from birth to 16 years of age. The
water fluoride ion concentration is in measurements of parts per million, or ppm. (AAPD, 2018)
As the chart above shows, younger ages only require a small amount and a small
concentration of fluoride in order to gain the benefits of this element and to protect their teeth.
The dental health care provider must make sure fluoride measurements are accurate for each
patient based on their age and personal dental needs. If more fluoride than the necessary amount
is used, fluorosis can occur. In these cases, the patient will usually experience nausea and
vomiting until this element is out of their system completely. This same concept applies for at
home use of fluoridated products for the patient. Fluoridated products such as toothpastes and
mouthrinses is never to be swallowed. For children less than the age of 3, it is recommended that
no more than a smear of rice-sized toothpaste should be used. For children between the ages of 3
The Risks and Benefits of Fluoride in Drinking Water McKeveny
and 6, it is recommended that no more than a pea-sized drop of toothpaste be used on the brush
to help prevent the risk of fluorosis. Children 6 years and older should still only use pea-sized
amounts of toothpaste, but can start to use fluoridated mouthrinses in very small amounts
because it is known to help prevent dental caries. “Home use of fluoride products for children
should focus on regimens that maximize topical contact, in lower-dose higher-frequency
approaches” (AAPD, 2018) If these guidelines are followed closely than there should be a
decreases in the risk of fluorosis in patients, as well as an increase in the benefit of the patient's
teeth and oral health. Dental health care providers should strictly follow these guidelines in their
practice, as well as inform their patients of these guidelines in order to prevent health risks.
“Critical thinking is not something you do once with an issue and then drop it. It requires that we
update our knowledge as new information comes in. Time spent evaluating claims is not just
time well spent. It should be considered part of an implicit bargain we've all made.”
- Daniel Levitin
This quote directly mirrors the importance of evaluating claims when doing a research
project of any nature or of any discipline. One cannot fully understand, advocate, or determine
that certain research and concepts are valid until cases of policy are evaluated. By evaluating
cases of policy, a better understanding can be gained. In light of my thesis the risks and benefits
of fluoride in drinking water, there are many claims of policy that can be presented about this
matter. This topic has remained controversial for over 70 years now due to the two main
opposing sides on this issue. “Water fluoridation has come under increasing scrutiny as health
concerns, lack of efficacy in preventing tooth decay and ethical issues of administering
chemicals via the water supply have surfaced” (Dr. Joseph Mercola, 2018)
The Risks and Benefits of Fluoride in Drinking Water McKeveny
The current policy on fluoride addition of the drinking water in New York is that fluoride
levels must be monitored and kept within World Health Organization guidelines. Currently the
WHO set guideline permissible value of fluoride to not exceed 1.0 ppm, or parts per million. The
government allows for this practice of adding fluoride to continue because it is believed that
fluoride benefits the teeth and prevents dental diseases from occurring. The reason why it is
added to drinking water is because, although fluoride is a naturally occurring element in water, it
is not at a high enough level or concentration to actually protect the teeth. It is also believed that
since fluoride is known to protect the teeth, it can lead to less oral health complications in
general. Although fluoride can have its benefits and has been proven to help, rather than hinder,
some people's oral health in some cases, the practice of adding fluoride in drinking water is
failing because there are too many risks that directly correlate to the overconsumption of
fluoride. In addition, many people are very unhappy with this practice because they do not have a
say in how much fluoride they are consuming when they are drinking water. In the case of
adding fluoride to drinking water, the risks outweighs the benefits.
My claim of policy on this topic is the state of New York should ban the practice of
adding fluoride to drinking water. The banning of this practice would be a great success for
many reasons. One reason that the banning of this practice would be beneficial is because it
would significantly lower the risk of health calamity. Since fluoride is known to be directly
correlated to certain health issues, such as dental fluorosis, skeletal fluorosis, arthritic symptoms,
bone fracture, cancer, and human intelligence, the risk of these diseases can be reduced
substantially.
Another reason why banning the practice of adding fluoride to drinking water would
bring about a great outcome is because the people would have consent in what they are
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consuming and the levels of fluoride they intake. This problem has been one of the hardest to
resolve in past years and especially with the latest policy, which causes extreme controversy. If
this practice does get banned, the people who still want to have fluoride levels within the WHO
guidelines still can, however they would need their own at home filtering system which would
add this element to only their drinking water. This way everyone can consent to what they are
intaking into their bodies.
The last main reason why banning this practice could produce a great result is because by
preventing this addition of fluoride to drinking water, the risks are being reduced, however the
benefits that this element presents can still be acquired. The addition of fluoride in drinking
water in the state of New York is not necessary because it harms more than it helps. The
concentration that is added to New York water is not significant enough to produce a beneficial
outcome, thus fluoride in drinking water only puts people at risk of overconsumption.There is a
much higher chance of gaining the benefits while avoiding the risks by implementing this policy
because people are able to intake and get enough fluoride supplements with toothpaste,
mouthwash, and fluoride treatments administered by the dental hygienists at their office.
Although the claim of policy of banning the practice of adding fluoride to drinking water
can produce many great outcomes and benefits, the New York State government will probably
not change its policies, even if there is a solution and a reason that may be more beneficial and
logical in terms of this current issue. Although banning this practice can potentially produce
many great results, it is also important to understand why there are still some people, including
the New York State government, who find it essential to have this fluoride supplement added to
the drinking water. In order to understand the reasons why some believe fluoride is actually
The Risks and Benefits of Fluoride in Drinking Water McKeveny
beneficial, rather than harmful, in addition to completely analyzing this issue at hand, it is also
crucial to look at the counterclaims that can exist on this issue.
“ To effectively communicate, we must realize that we are all different in the way we perceive
the world and use this understanding as a guide to our communication with others.”
- Tony Robbins
I picked this quote by Robbins for this week because I have finally gotten the chance to
conduct my first interview and I feel that after this interview was conducted I gained a greater
understanding and saw a different perspective of the topic I am researching. In order to gain a
complete understanding and to fully grasp the viewpoints and values of others, we must first
have an open mind and have a realization that the way we all perceive the world varies greatly,
due to differences in culture, personal experience, principles, and knowledge. For the past couple
of weeks I have been researching and expanding on my resources in order to understand and gain
a complete view of the matter of whether or not fluoride in drinking water is safe, and if not
should it then be used in the field of dentistry?
This past week I had the please to interview someone that I have learned a great deal
from over the past 5 years. Subject A. has much background knowledge about the topic at hand,
in addition to insightful personal and professional opinions and views of this topic. After
interviewing him, I was able to acquire a better sense of the true issue at hand in regards to
fluoride in drinking water and its effect on dental practice. from somebody that has much
knowledge about this current issue. This interview was conducted over the phone in 2 sessions.
Subject: A
The Risks and Benefits of Fluoride in Drinking Water McKeveny
Profession: Scientist/ Professor
Two sessions: Session 1: Friday 10-12-18
Session 2: Sunday 10-14-18
Session 1:
Interview Introduction: I am studying and doing research on the benefits and risks that fluoride
presents in the groundwater in developing regions of the world such as India and Bangladesh,
and comparing those risks and benefits to that of the state of New York. I will then be applying
these findings to see whether or not the use of fluoride is safe and beneficial in the practice of
dentistry.
First I just wanted to state that many people do not believe high fluoride intakes and
exposure to high fluoride concentrations is that serious. I wanted to know where you stand
and how serious you think this issue is?
A.- It is not an issue here in NY, but fluoride content in water is very important and specific to
health related issues. Too little fluoride and too much fluoride can both cause health problems.
The World Health Organization, the WHO, allows fluoride levels of 1.5 ppm or milligram per
liter. Water ove here is mostly surface water, including precipitation water, so mainly rain water
or snow water. This New York water and the natural groundwater does not have enough fluoride
in New York. If you do not have close to 1 ppm of fluoride intake then that can cause fluoride
deficiency for tooth enamel which causes tooth decay. The fluoride is added in NY because there
is actually not enough naturally occurring water so the WHO needs to supplement fluoride. In
areas like Southern India, this issue is actually very serious though.
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The enamel of the tooth is mostly made of calcium phosphate, but the fluoride actually replaces
this enamel minerale with fluoride. The tooth then becomes brittle and breaks, or decays. The
problem in Bangladesh is different. It is not as serious as of an issue as South India, but it might
be a serious issue later on. In india it is a very serious issue because the fluoride in the
groundwater over there more than 5 ppm and intaking that for a long time can cause toxic effect.
Some areas in Southern India have fluoride levels from 10 ppm to even 38 or 40 ppm of fluoride
in water, which is very high and unsafe. Fluoride in these regions is there naturally and is not in
the water through treatment like New York water is. People in Bangladesh depending on
groundwater as their source of drinking water and any excess fluoride can cause fluorosis. The
work I have done in my profession was mostly concerned with arsenic levels in groundwater.
But some sediments in Eastern Bangladesh, even if there is no levels of arsenic, there could still
be fluoride. Most groundwater is still safe but a lot has fluoride higher than 1 ppm. If the fluoride
is not naturally leaching out of rocks then it is safe. The fluoride levels might increase over time
there. As far as water in New York, I think it is okay. I know that most water treatment in NY is
okay and controlled. Geographically Bangladesh and regions of Eastern India share some similar
minerals so it can potentially cause serious effect. Ground water might have fluoride due to
intrusion of seawater. We found some high level, higher than 1 ppm, fluoride in some areas of
Bangladesh, but it is not a serious toxic level yet.
Has high fluoride intake levels affected you or your family directly?
A.- No, I have no been directly affected by high fluoride levels and neither has my family or the
people I know. I am from Bangladesh but have been living in the United States with my family
for many years now, and the New York drinking water does not present any health threats right
now. In Bangladesh it is not that serious of an issue and we have not come across much chemical
The Risks and Benefits of Fluoride in Drinking Water McKeveny
fluorosis. The data shows there is nothing to worry about and we don’t known and have not seen
any people affected by excess fluoride. Water has fluoride within permissible levels in
Bangladesh. Our bodies do need some fluoride intake in order to prevent some health problems.
Over there (Bangladesh) it is naturally occurring in the water. There is some fluoride that
naturally occurs but it is within safe regions. My colleague works over there and he says that in
the southern part of India it is a serious issue. Especially in the cities of Kerala and Karnataka.
In india the problem is pretty serious. Globally there is 85 million tons of fluoride deposits, and
12 million tons are found in India alone. Fluoride concentration is very widespread and very
serious. This is an important public health issues in 24 countries now, including india. The
fluoride belt extends from Turkey to China and Japan. Natural fluoride deposits are found in
India and affects lots of the population. In India 62 million people are affected by the fluoride
contamination of water by fluorosis. It is very obvious India has serious fluoride issue from
groundwater.
In regards to the negative effects fluoride and high fluoride intakes can have on people who
reside in a specific geographical area, in your personal and professional opinion is there
any way to resolve these problems and what actions should be taken in order to do so?
A.- As far as New York and Bangladesh are concerned, there is nothing to do right now since the
levels of fluoride in the drinking and groundwater is not toxic. For the dangerous fluoride levels
present in India, there needs to be a meeting with some officials for some form of filtration
situation to be implemented. The people in this region are exposed to excess fluoride through
groundwater and they have to remove it. Filtration is only way to fix this problem. The source of
water over there is surface water, so if a filtration system is not implemented then the people
have to change their source of water. They must seek out ground or surface water that has a
lower fluoride level. First of all they have to look at the net source of all water and filter all
The Risks and Benefits of Fluoride in Drinking Water McKeveny
excess fluoride. The people can utilize rainwater or even they can search for groundwater that
has low fluoride, but they have to be very selective. If this cannot be done then they have to
introduce a filtration system. In my experience, the filtration systems I have used to remove
arsenic, was also tested for removal of manganese and tested ion filtration system. This filtration
system can remove low fluoride levels in Bangladesh, but I do not know how they would do that
with higher levels found in India. In India the fluoride levels are from 30-40 ppm and these
levels are very serious and dangerous. The states I can mention that have been worst affected by
high fluoride levels in groundwater is Andhra, which is the area that is the worst affected in
south India. In the northern part of India the worst affected state is Gujarat. A few other states in
India are moderately affected which are West Bengal, and a state called Assam. Assam has a
border with Bangladesh, so if this state is already moderately affected by high fluoride levels
then Bangladesh could be affected as well in the future. Bangladesh currently has a fluoride level
of 1 ppm in the groundwater. Anything close to 1 ppm is a borderline case. If it goes over 1.1 or
1.2 ppm then the fluoride levels should be looked at. If Bangladesh eventually becomes
moderately affected as well then intervention has to be taken.
Session 2:
Interview Introduction: To continue this interview and gain a greater understanding of this
issue and your experiences, as well as your personal and professional opinions and viewpoints, I
will be asking a few more questions.
Being that you have first hand seen the effect of high fluoride in the ground water of
Bangladesh, and have also first hand seen how fluoride is added to our New York drinking
water, How do you feel about fluoride being added to the drinking water of New York,
The Risks and Benefits of Fluoride in Drinking Water McKeveny
when naturally occurring fluoride in drinking water has caused problems in other regions,
like Bangladesh?
A.-Fluoride is essential for the body. If you do not have fluoride it can cause problems with tooth
decay and that is why fluoride is added in New York. I think this practice is okay in NY. Even
toothpaste and mouthwash have fluoride and since these products have it, people can be exposed
with this as well. This is all within permissible value to prevent tooth decay. Water that is treated
in New York is not groundwater. There is no natural fluoride so they supplement because it is
needed and essential for people to have. But in Bangladesh and India that is separate issue. The
fluoride in the water comes from bedrock and sediments. Over there it is a toxic issue, so they
have to remove it, especially in India. Right now Bangladesh has the best situation because they
do not fluoridate or treat water, but they have naturally occuring fluoride at 1 ppm or less. The
main problem in Bangladesh now is high levels of other toxic elements like arsenic. Here in New
York it is okay and it is not too much. Fluoride is actually essential. Keep in mind toothpaste or
mouthwash has fluoride and that is okay for people to consume.
Based on your professional and personal opinion and based on your experiences, Do you
think it is safe to use fluoride in the field and practice of dentistry?
A.- I’m not sure because I do not have much of a background in dental materials and what is
used in the dental field. I would have to see the level of fluoride in toothpaste and mouthwash,
but I assume it is a very little amount. I think it is probably safe, but the reason fluoride is added
to water in New York is because water is something all people drink. Fluoride levels in this
water is low and since it can also be dangerous for people to be underexposed to fluoride intake
it is supplemented in the water. Not everyone uses mouthwash or goes to dentist so adding to
fluoride to water is supplemented for all people, and that way they can ensure nobody is
underexposed. I think this practice is still good. The water is tested and monitored so we can get
The Risks and Benefits of Fluoride in Drinking Water McKeveny
good amount and level. All people in New York are exposed to good levels of fluoride
supplements. An example to compare is table salt is iodized so people can get sufficient iodine
intake, so this is basically the same thing with the water. The people are at least getting the
essential amount needed to prevent tooth decay.
Do you think that those who still want to gain some of the positive effects fluoride could
have on their oral health can gain it through use of different dental materials, such as
fluoridated toothpaste, mouthwash, and the fluoride treatments administered from their
dental health care provider?
A.- I cannot say totally about the use of excess fluoride. In New York fluorosis is rare, and most
likely does not happen. Toothpaste and mouthwash fluoride levels is still not going over the
WHO permissible guidelines and is still not toxic. This may vary from person to person. But I
think for the general population it is a good idea
What do you wish to see in the future? How do you think we can solve this problem and
what actions do you think need to be done?
A.- I think there is nothing to worry about in New York and that it is a good idea to continue to
fluoridate the water here. This is my opinion. Just look at WHO level and what is needed. For
tooth health and tooth decay we need fluoride. We have the best quality of water here. Water in
Bangladesh and Southern India is bad in comparison to New York, and to even other areas of the
U.S., but New York has the best water. New York has excellent water quality. In India and
Bangladesh the surface water is bad. This is due to much Indiscriminate dumping of waste which
is not very controlled. The surface water and groundwater is contaminated by natural sources.
There is no industrial issue over in those regions, fluoride naturally contaminates the water so
they have to actually filter it. In India especially, they need to remove all contaminants and look
for groundwater that is safe. There is a lot of groundwater that is safe and free from all elements
The Risks and Benefits of Fluoride in Drinking Water McKeveny
in Bangladesh. Excess of anything and any element is always toxic. Even essential trace element
that are too high over the guidelines can cause health effect. Bangladesh has to be on guard about
this potential problem and in India this is already a serious issue that needs to be fixed. Efforts
need to be made. They have to purify the water over there. It is two very different worlds. In
New York, we are okay but over there it is not okay and they face all kinds of issues. Also this is
not just in India and Bangladesh, fluorosis is an issue in at least 24 countries. Even here in New
York there is a possibility that there may be some fluoride in groundwater that is naturally
occurring. This groundwater must also be tested and monitored.
At completion of conducting this interview, I realized how much I gained from speaking
to someone who has great knowledge about this topic, as well as a broad perspective of the
effects of fluoride. Although what A. said regarding fluoride differed from what most of my
scientific resources states, I think it was more beneficial that I was able to gain an understanding
of both sides of this controversial topic and have a greater understanding of the true issues at
hand.
“I think it's very important to have a feedback loop, where you're constantly thinking about what
you've done and how you could be doing it better. I think that's the single best piece of advice:
constantly think about how you could be doing things better and questioning yourself.”
- Elon Musk
I picked this quote for this week’s writing because I felt I strongly related to it, especially
at this point in my writing experience and research. Throughout my writing and research
experience thus far, I have come to realize and understand the importance of not only gathering
information, but analyzing that information and asking myself how can I better apply this
information and research to a bigger problem to provide possible solutions. Although I feel I
The Risks and Benefits of Fluoride in Drinking Water McKeveny
have accomplished a lot with my research journey, there are still questions that need to be
answered, and work that has to be done before my research is fully completed. Throughout my
research and writing process for this course, after each week I constantly questioned what more I
should do for the coming weeks and how I can better my writing, research, and problem solving
skills. I feel that one of the most enlightening experiences I had during my research so far was
conducting my interview with Subject A. This source really helped to provide me with some
helpful insight, as well as allowed me to start questioning and viewing counterclaims of my
topic.
One of the things that I felt I needed for this research to feel more complete and accurate
was to try to do another interview with someone who had been a bit more personally affected by
the issue of fluorosis. It was hard to find someone that I could interview, especially being that
many people who are seriously affected are from developing regions of the world. However,
with some help, I was able to conduct a phone interview with Subject B. Although I do not
personally know Subject B, Subject A from my first interview helped to put me in contact with
this person, which was very helpful since I felt I would be able to obtain an even broader view of
this issue at hand. Subject B has a more personal experience with the issue of fluorosis, due to
the fact that his niece was exposed to higher fluoride intakes as a baby. Subject B currently lives
in New York, however is originally from Assam, which is a state in India that is known to be
moderately affected by fluoride levels in groundwater. Subject B frequently visits Assam still to
see his family. In my interview with Subject B, I was able to gain an understanding of another
view of this issue at hand. This interview was conducted over the phone in 1 session.
Subject: B
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One session: Friday 11-2-18
Interview Introduction: I am studying and doing research on the benefits and risks that fluoride
presents in the groundwater in developing regions of the world such as India and Bangladesh,
and comparing those risks and benefits to that of the state of New York. I will then be applying
these findings to see whether or not the use of fluoride is safe and beneficial in the practice of
dentistry.
First I just wanted to state that many people do not believe high fluoride intakes and
exposure to high fluoride concentrations is that serious. I wanted to know where you stand
and how serious you think this issue is?
A.- I think that this issue can have certain health problems on children who are exposed to high
levels of fluoride. Most of my family still lives in and around Assam. Growing up I never knew
or understood that high levels of fluoride in the water was dangerous. It is easy to just drink the
water that comes from the groundwater in India. I have been living in New York for many years
now and after I met Subject A and he informed me about the certain health calamity higher
fluoride intakes can cause in certain areas, especially my home in Assam. Growing up, I never
faced many problems because of the drinking water. People who had problems that could have
been related to this higher intake of fluoride did not always relate their health problems to their
water drinking source. However, living in New York for over the past 25 years I met many very
intellectual people who have made me aware of this issue. A few years ago my niece, Aasya, was
starting to have some trouble reaching some developmental milestones. My brother and his wife
took Aasya to some doctors but they were unable to determine exactly what the cause of this
delay was. I talked to some people I know here in the United States about this issue my niece
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was having, including Subject A. It was then that I realized the intake of fluoride could be a
possible cause of this intellectual and milestone setback. I told my brother about this and he then
made the effort to change Aasya’s source of water from the groundwater to a source that was
known to be more safe. The doctors that saw my niece said that sometimes some children just
have delayed milestones, but that a lot of the time they do eventually meet those milestones. This
delay could be related to a number of things. Thankfully, after some time Aasya did start to hit
her milestones the way her doctors had expected. Although Aasya’s delay could have been from
a number of things, I started to think that it was was not until after we had changed Aasya’s
water drinking source that she had started to reach her milestones. I am just happy that she is
progressing the way that the doctor’s had hoped and is healthy and happy now. However it does
make me question if this fluoride in the drinking water back over there can cause serious health
problems or not.
(My next question was going to be “Has high fluoride intake levels affected you or your family
directly?” but Subject B already included his experience with that in my first interview question
to him.)
In regards to the negative effects fluoride and high fluoride intakes can have on people who
reside in a specific geographical area, in your personal opinion is there any way to resolve
these problems and what actions should be taken in order to do so?
A.- It is hard for me to say a definite answer to this question. My whole family and myself
included have resided in Assam for many years and have not had health problems because of the
drinking water. However, I now know that this state is particularly known to have high fluoride
levels and can potentially cause health problem in people and children over there that consume
this water. My niece, on the other hand, did have delayed milestones and once her source of
water was changed she then started meeting these milestones. But, her doctors did not say that
The Risks and Benefits of Fluoride in Drinking Water McKeveny
this was the definite reason she was no longer being delayed. I am not sure if this is just a
coincidence since this delay in milestones does happen to some children or not. I think perhaps
over there (Assam) should be studied more in order to see how serious these issues related to
fluoride actually are so we can figure out if any action should be taken.
Being that you now know what the effect of high fluoride intake in the ground water of
regions such as Bangladesh and India could potentially cause, and have also first hand seen
how fluoride is added to our New York drinking water, how do you feel about fluoride
being added to the drinking water of New York, when naturally occurring fluoride in
drinking water has caused problems in other regions, like Assam, India?
A.- At first I was a bit skeptical myself about the fluoride addition to New York water after
finding out fluoride can have some negative effects on health and after the problems my niece
was having that could have been caused by fluoride intake. However, after speaking to some
people, including Subject A, I realized that fluoride also provides positive effects as well. Since
in New York it is monitored I think it is okay because it is at a good level. Back over there it is
not monitored which is what may be causing some of the health problems.
Based on your personal opinion and based on your experiences, Do you think it is safe to
use fluoride in the field and practice of dentistry?
A.- I do not have much knowledge about fluoride and its use in dentistry so I cannot say a
definite answer to this. I think that if it is monitored and if it is determined to be safe then this is
one of the positive effects that fluoride has.
Do you think that those who still want to gain some of the positive effects fluoride could
have on their oral health can gain it through use of different dental materials, such as
fluoridated toothpaste, mouthwash, and the fluoride treatments administered from their
dental health care provider?
The Risks and Benefits of Fluoride in Drinking Water McKeveny
A.- I cannot say for sure because I do not know much about fluoride and its use in the dental
practice, but if it is monitored by health care professionals then I think it is okay. Also I have
learned that some fluoride is actually necessary so if it is for a positive health effect then I think
it is okay to use.
What do you wish to see in the future? How do you think we can solve this problem and
what actions do you think need to be done?
A.- I think that if over there (Assam) in India is really having concerns with the level of fluoride
in the water it should be monitored more closely so there are not anymore health problems due to
high fluoride intake in the water. For my niece, I think that changing her water drinking source
might have helped her problem and stopped the delay from continuing, but I cannot say this for
definite. But, monitoring the water over there cannot hurt.
At completion of conducting this interview, I felt I gained a greater understanding from speaking
to someone who had a more first hand and personal experience with this issue. The fact that him
and his family are all originally from Assam, India which is one of the states that is well know to
have moderate levels of fluoride in their drinking water, helped me to feel that I had an accurate
primary source to refer to when going back and analyzing the rest of my research that I had
already conducted and plan to conduct. Although it is not definite that changing the drinking
water source of Subject B’s niece helped her problem, or reversed the possible effects higher
intake of fluoride could have caused, it is most definitely something to consider. Also at the
completion of this interview, I realized that there are certain points to my original claim that
seem to be true, and others that I need to look into and question more. What I now plan to look
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into more thoroughly is if fluoride use in dentistry really does propose a very positive health
effect on people or not.
“Research is creation of knowledge which leads to new and efficient solutions for the society.”
- Shiv Nadar
This quote by Nadar is very relatable for me during this week of my research journey. At
this point in the semester I feel I am finally gaining enough background information and research
to start applying my findings in order to solve my original, bigger problem. I have questioned
whether or not fluoride in drinking water is a safe or unsafe practiced and looked at different
regions of the world to help me have a better understanding if fluoride is, in fact, safe to use in
the practice and field of dentistry. Now that I have gained much information and understanding
about the fluoride levels in drinking water, looked into the health effects high fluoride intakes
can cause, as well as conducted 2 interviews, I feel that I am ready to take this information and
look at it on a greater scale to help me determine if fluoride use is beneficial in the practice of
dentistry.
After comparing the drinking water of New York to that of developing regions of the
word such as Bangladesh and India, I came to realize that although too much fluoride intake can
cause negative health effect, too little fluoride can also have adverse effects on dental health.
Fluoride is a naturally occurring element in the earth, and is also known to be naturally occurring
in the human body. “Fluoride is an important and essential mineral that forms a main constituent
of the bones and teeth.” (Dove Med, 2016) This element actually plays a very important role in
providing protection of our teeth and some of our vital organs. Fluoride maintains a certain level
of strength and structure throughout our bodies, which is not only good for our bones, but also
The Risks and Benefits of Fluoride in Drinking Water McKeveny
helps to protect our internal organs, specifically our brain, spine, heart, and lungs. Without any
fluoride we risk weakening our overall health. (Dove Med, 2016)
Although fluoride presents many great effects for our bones and strength of our bodies,
the greatest health advantage that fluoride provides is its aid in the protection of our oral health.
The effect fluoride can have on oral health, when monitored correctly, can actually lead to great
benefits and outcomes. Fluoride strengthens the enamel of the teeth and provides the tooth with
the essential minerals that may be lost over time, thus preventing decay and dental caries.
“Fluoridated water supplies and toothpaste are so effective that that they have been credited as
part of the dramatic drop in tooth decay and cavity occurrence that has taken place over the past
50 years.” (Chemical Safety Facts, 2018)
In New York, because the level of fluoride in the drinking water is monitored, it is not
only safe to consume, but also beneficial and recommended. The WHO sets permissible fluoride
guidelines for different states so that the risk of high intake and excess fluoride in the drinking
water is avoided. Just for an example, our New York fluoride level in the drinking water is
slightly higher than that of a place like Floride. This is because Florida is much more hot and
humid, leading to more frequent thirst, and more consumption of water by the people that live
there. These are factors that are considered by the World Health Organization so that health
calamity is avoided, and also so that the greatest benefit can be achieved. Water fluoridation has
actually produced so many great benefits over the past 50 plus years that the CDC actually listed
community water fluoridation as one of the top 10 greatest public health achievements of the
20th century. (Chemical Safety Facts, 2018)
In the practice and field of dentistry, the use of fluoride is essential and beneficial for
patient care. “Without good daily oral hygiene and regular dental visits, teeth become more
The Risks and Benefits of Fluoride in Drinking Water McKeveny
vulnerable to caries.” (ADA, 2007) Besides brushing 2-3 times a day and flossing, the use of
fluoridated toothpastes, mouthwash, and at home fluoride treatments is a good way for people to
maintain healthy teeth, gums, and overall oral health in between dental visits. People should see
their general dentist and get a dental cleaning every 6 months in order to prevent possible oral
health problems. If a dental health care provider notices a particular person is at moderate-to-
high risk of developing caries, then a professional fluoride treatment can be administered at the
dental office. “The fluoride preparation used in the dental office is a much stronger concentration
than that in toothpastes or fluoride mouthrinses that may be available in a store or at a
pharmacy.” (ADA, 2007) This professional treatment can significantly decrease the chances of
that patient getting dental caries or decay in the future. Professionally administered fluoride
treatments can be given every 3, 6, or 12 months depending on the oral health of each patient.
(ADA, 2007) The use of fluoride in the dental field is very helpful and has been proven to yield
many positive results for the patient's overall oral health.
“Watch every detail that affects the accuracy of your work.”
- Arthur C. Nielsen
This quote by Nielsen strongly relates to the writing style that I have been working on
and trying to improve throughout the course of this semester. As the course of this semester
progressed, I realized and started to understand how important specific details are when writing a
thesis. The specifics and details dealing with the claims I am making allows my audience to
believe and understand that I am a reliable source and that the information I am providing is
accurate. In order to provide information and research that is valid and accurate, close attention
to detail must be obtained.
As I have previously discussed, there are many benefits to consuming and using fluoride
in the practice of dentistry. However, too much or too little fluoride can provide potential serious
The Risks and Benefits of Fluoride in Drinking Water McKeveny
risks and health calamity, which is why it is very important for dental health care provided to be
aware of how much fluoride is permissible for each of their patients in order to provide the
benefits but avoid the risks this element can provide. In the practice of dentistry fluoride therapy
is administered topically to patients. The specific needs and the age of the patient are the main
factors that determine the amount of fluoride that is administered to each individual patient.
It used to be believed by experts in the dental field that fluoride was only beneficial in
strengthening teeth that were still growing and developing. This is why fluoride therapy
treatments were only done on children and why all fluoridation efforts were mainly focused on
children’s teeth. However, new research now shows that fluoride treatments can be beneficial for
people of all ages. “Studies now show that topical fluoride — the kind in toothpastes, mouth
rinses and fluoride treatments — helps fight decay in people of all ages.” (Colgate-Palmolive
Company, 2018)
In the case of administering fluoride therapy treatments to adults, similar guidelines to
that of children are followed. Although fluoride is know to particularly help and strengthen the
developing teeth of children, it is also known to strengthen the teeth and prevent dental caries in
adults patients and elderly patients. It is the case that most adults who live in regions with
monitored fluoridated water, that brushing with fluoridated toothpaste and using the fluoridated
water is actually enough to gain the benefits of this element while avoiding the risks. However,
patients, particularly elderly patients, who suffer from certain conditions such as dry mouth, high
risk for caries, and gingival recession, professionally administered fluoride therapies may be
required. (Colgate-Palmolive Company, 2018)
For most healthy adults, there is no real need for professionally administered fluoride
therapy treatments, due to the fact that there is no reason to expose a patient to excess fluoride
The Risks and Benefits of Fluoride in Drinking Water McKeveny
when it is not needed. In cases where a patient is at high risk for developing caries then
professional and at-home fluoride therapies may be utilized. According to the American Dental
Association “Adults should have 2.26% fluoride varnish applied for both coronal and root caries.
Varnish should be applied at least twice per year for root caries prevention.” (BDA, 2014) The
chart from the Journal of the American Dental Association provided below shows the clinical
recommendations for use of professionally applied or prescription-strength, home-use topical
fluorides for caries prevention in patients at elevated risk of developing caries. (JADA, 2013)
As the chart above shows, for patients older than 18 years of age, fluoride therapy
applications are to be determined by the dental healthcare professional. Since not every adult
necessarily needs fluoride therapies in the way that children do, each patient is to be treated and
The Risks and Benefits of Fluoride in Drinking Water McKeveny
prescribed a dosage based on their own individual needs. For elderly patients who may need a
professionally applied fluoride treatment, but may suffer from dementia or forgetfulness, or may
be prone to swallowing excess fluoride, a lower dosage may be used so that a mild form of
dental fluorosis does not occur. However, and elderly patient who is in need of fluoride therapy,
but does not have other health and mental issues such as dementia, may be administered a
slightly higher dosage if the primary dental healthcare provider deems this patient to be safe. For
children, the guidelines of fluoride application are more definite and accurate, but for adults it is
slightly different due to the fact that adults often times have more various oral health needs or
concerns than children do. (JADA, 2013)
Regions, such as New York, that have monitored fluoridated water levels, have often
times been proven to have a population that shows to have decreased risk for dental caries. Due
to the fact that regions with monitored permissible fluoride water levels can provide beneficial
results to the oral health of that population, it is often times the case that patients over the age of
18 do not necessarily need other fluoride therapy supplements other than their fluoridated
toothpaste and water to maintain good oral health and prevent dental caries. However, in the case
that a patient does have oral health problems and is at a higher risk for developing caries, it is
then up to the dental healthcare provider what fluoride supplements should be added into that
particular patients oral health care regime and what dosages should be considered for that
patient’s individual needs and treatment plan.
“Knowledge once gained casts a light beyond its own immediate boundaries.”
- John Tyndall
The Risks and Benefits of Fluoride in Drinking Water McKeveny
I chose this quote by Tyndall for this week to reflect on the information and knowledge I
have gained throughout my writing process this semester, in addition to apply all the knowledge
I gained to a greater application in my final paper. Throughout my research journey I have
gained much insight and knowledge about the benefits and risks of fluoride and how various
levels can affect people of different regions of the world and people who have certain conditions.
However, I realized that it is important to look at the bigger picture when applying this
information and to connect the different facts and situations from my research to one another. By
making connections and relating ideas, information, and studies to one another, a greater
understanding and result can be achieved.
As I have previously discussed, there are both beneficial and risk factors to be considered
before consuming fluoride systemically or topically. In general, consuming too much of
anything is never good, which is why there must be a permissible level of fluoride or a set limit
of how much fluoride a person can consume. In developed regions, where the level of fluoride
added to the water supply is monitored, it is not only allowed, but recommended by the ADA for
people to also talk to their primary dental health care provider about being administered fluoride
supplements. “The Association strongly urges communities that already are doing so to continue
fluoridating water at the levels the government recommends. People who live in the dwindling
number of non-fluoridated communities should help educate their state and local officials about
the need to fluoridate. They also should talk to their dentists about other ways to ensure that they
are receiving the right amount of fluoride, through such means as supplements or topical
applications.” (ADA, 2018)
In regions that are still developing and have trouble maintaining and controlling the
amount of fluoride in their water supply, any extra fluoride treatments should be avoided. This is
The Risks and Benefits of Fluoride in Drinking Water McKeveny
due to the fact that if a person is already at a high risk of developing some form of fluorosis,
excess fluoride consumption would not be beneficial. This same idea holds true for people who
are originally from developing regions such as certain areas of Bangladesh and India who then
move to a more developed region of the world, for example the United States. Dental health care
providers may want to note where their patient is originally from and analyze whether or not this
person has signs of mild, moderate, or severe fluorosis of any kind before administering or
suggesting fluoride treatments. However, if a dental health care provider does notice that a
patient has suffered from dental fluorosis, there are treatments that can be done to cosmetically
correct how the teeth look. Although fluoride treatments should still be avoided, people who are
at high risk of fluorosis or suffer from a certain amount of fluorosis should still undergo
treatments from their dentist and dental hygienist in order to correct and prevent any problems
they may have. “In mild cases of fluorosis, no treatment is required. However, in more severe
cases there are several fluorosis treatment options aimed at improving the appearance of affected
teeth. Fluorosis treatment options include: removal of stains through tooth whitening, adding a
hard resin coating to the tooth which bonds with enamel (known as bonding), crowns and
veneers.” (Procter & Gamble, 2018)
There may be a fear that going to the dentist and undergoing dental treatments can cause
a higher risk of fluorosis for patients who do not present signs of this condition, and worsened
cases of a developing condition of fluorosis. However, this is not the case. Dental health care
providers should know the concentration of fluoride in the water supply of the specific region in
which they are practicing. Based on this concentration, their patients’ individual needs, and the
risks and conditions each patient is particularly exposed to, the dental health care provider is
responsible to provide a detailed treatment based on each patient for optimal care. In all patient
The Risks and Benefits of Fluoride in Drinking Water McKeveny
cases, the dental health care professional will be able to provide information based on how much
fluoride each patient is allowed and treat each patient for their own specific needs.
The issue and debate of fluoride benefits and risks may never be fully resolved without
continuing research and case studies on this topic. However, I feel that based on my own
research and writing experience, I have gained much insight and knowledge about this topic. To
answer, in short, the big question that I have been exploring all semester: “Is there a way to gain
the benefits, while avoiding the risks when consuming fluoride?”, yes. With the guidance, care,
and information provided by dental health care professionals, the benefits of fluoride can be
achieved, while the risks being avoided or prevented through dental treatment. However, in cases
of people living in developing regions of the world, this problem can be harder to overcome and
resolve. Until the water sources in regions where fluoride concentrations is detrimental is
controlled, there has yet to be a set way to provide optimal patient dental care. Once these bigger
environmental issues are resolved and under better control by the government, then the dental
health care providers in these regions, and even outside of these regions, have a better chance of
providing the people and patients’ of these regions with the best treatment possible.
After concluding all of my research, gathering my information, conducting interviews,
and completing this thesis, I have gained one of the greatest learning experiences ever. Although,
at times, it got frustrating when I felt I could not find the facts and information I was trying to, or
when some claims, as well as one of my interviews, went against some of my original beliefs
about fluoride, I feel that I am ending this semester with a great sense of success and
accomplishment. Of course, just like any field or topic, more research can always be done and
should always be explored in order to figure out new solutions and find new methods in order to
test our theories and have a greater understanding of what we are studying. Although I
The Risks and Benefits of Fluoride in Drinking Water McKeveny
discovered much these past 15 weeks, a true researchers work is never fully completed. I believe
that more can always be explored, studied, discovered, and solved. However, the skills I
developed as a researcher, and as a writer throughout these past 15 weeks will most definitely
benefit me in any field of practice and in any other study I wish to delve into in the future.
The Risks and Benefits of Fluoride in Drinking Water McKeveny
Bibliography
Alauddin, M., et al. Fluoride in Groundwater in Eastern Hill Tracts of Bangladesh. Geological
Society of America. Retrieved from
https://gsa.confex.com/gsa/2016AM/webprogram/Paper287927.html (2016)
American Dental Association. Fluorosis. Retrieved from https://www.mouthhealthy.org/en/az-
topics/f/fluorosis (2018)
American Dental Association. ADA Applauds USPHS Final Recommendation on Optimal
Fluoride Level in Drinking Water. Retrieved from
https://www.ada.org/en/public-programs/advocating-for-the-public/fluoride-and-
fluoridation/ada-applauds-hhs-final-recommendation-on-optimal-fluoride-level-in-drinking-
water (2018)
American Dental Association. Fluoride treatments in the dental office: Extra protection for your
teeth. Retrieved from
http://www.ada.org/~/media/ADA/Member%20Center/FIles/patient_72.ashx (2007)
American Dental Association and the American Academy of Pediatrics. Fluoride Therapy.
Retrieved from
http://www.aapd.org/media/Policies_Guidelines/BP_FluorideTherapy.pdf#xml=http://pr-
dtsearch001service/search.asp?cmd=pdfhits&DocId=449&Index=F%3a% (2018)
American Dental Association. Fluoride: Topical and Systemic Supplements. Retrieved from
https://www.ada.org/en/member-center/oral-health-topics/fluoride-topical-and-systemic-
supplements (2017)
Anon: Ten Commandments II- poetic diagnostic
BDA Evidence Summary. Fluoride varnish in older persons. Retrieved from
https://bda.org/dentists/education/sgh/Documents/Fluoride%20varnish%20for%20older%20peop
le%20is%20this%20a%20good%20idea.pdf (2014)
ChemicalSafetyFacts.org. Fluoride. Retrieved from
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HCMsaOWLx9XIZ4vcIWP7ESzwDYrfiY5O7wDujcST3Fw3gRH8aAjbwEALw_wcB (2018)
Cheng, K K, et al. Adding Fluoride to Water Supplies. U.S. National Library of Medicine.
Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2001050/ (2007)
Colgate-Palmolive Company. Adults And Fluoride. Retrieved from
https://www.colgate.com/en-us/oral-health/basics/fluoride/adults-and-fluoride (2018)
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Committee on Fluoride in Drinking Water, Board on Environmental Studies and Toxicology,
Division on Earth and Life Studies, National Research Council. Fluoride in Drinking Water: A
Scientific Review of EPA's Standards. National Academies Press (2006)
DoveMed. What Are The Health Benefits Of Fluoride?. Retrieved from
https://www.dovemed.com/healthy-living/wellness-center/what-are-health-benefits-fluoride/
(2016)
Fluoride Action Network. Dental Fluorosis. Retrieved from
https://fluoridealert.org/issues/fluorosis/ (2018)
Fluoride Action Network. Skeletal Fluorosis. Retrieved from
https://fluoridealert.org/issues/health/skeletal_fluorosis/ (2018)
Greene, B. Science is a way of life. Science is a perspective. Science is the process that takes us
from confusion to understanding in a manner that's precise, predictive and reliable - a
transformation, for those lucky enough to experience it, that is empowering and emotional.
Hileman, B. Fluoride Risks Are Still A Challenge. Retrieved from
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from
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requires that we update our knowledge as new information comes in. Time spent evaluating
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made.
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(1997-2018)
Musk, E. I think it's very important to have a feedback loop, where you're constantly thinking
about what you've done and how you could be doing it better. I think that's the single best piece
of advice: constantly think about how you could be doing things better and questioning yourself.
Nadar, S. Research is creation of knowledge which leads to new and efficient solutions for the
society.
Nielsen, A.C. Watch every detail that affects the accuracy of your work.
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Nordqvist, C. Why do we have fluoride in our water?. Medical News Today. Retrieved from
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learning from failure.
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like, and do what you'd rather not.
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Outline
The Risks and Benefits of Fluoride in Drinking Water McKeveny
I. Introduction/Background
Fluoride in Drinking Water: pros & cons
Pros: 1) prevents dental caries and protects the teeth
2) needed for the body
3) benefits overall oral health care
4) too little fluoride also presents health risks.
Cons: 1) High intake and high fluoride concentration can cause health problems
2) People did not consent to this practice of adding fluoride to groundwater
II. Claim of Fact:
a) If fluoride is seen as a cause of serious health calamity in places such as Bangladesh, is
adding fluoride to drinking water in more advanced regions such as New York, a safe
practice?
- Yes.
b) Since fluoride is a known element to cause health problems, is using in in the dental field
a safe practice?
- Yes.
III. Claim of Value:
A) People are not well educated on the topic
- Dental health providers must inform their patients on fluoride and the permissible
amounts to consume in order to gain benefits, but avoid risks.
The Risks and Benefits of Fluoride in Drinking Water McKeveny
B) People do not have a say in what elements they intake in their drinking water and did not
give consent to this practice of adding fluoride to drinking water
C) Is there a way to consume fluoride while obtaining the benefits, yet avoiding the risks?
- AAPD guidelines and dosage amounts for patients.
- Can obtain benefits while avoiding risks, but must strictly follow guidelines
- Guidelines for children patients: AAPD dietary fluoride dosage chart
- Guidelines for adults/ elderly patients: JADA Table 4: Clinical Recommendation
Chart for fluoride varnishes.
Personal experiences: Done some research on fluoride levels in Bangladesh
Interviews: Interview 1: Subject A on their personal & professional opinion about
fluoride in drinking water. (counterclaim)
- Bangladesh
- India
- New York
Interview 2: Subject B on their personal experience and opinion on this issue.
(some points could be used to support my original claim)
- Assam, India
- New York
IV. Claim of Policy
A) “The state of New York should ban the practice of adding fluoride to drinking water.”
V. Conclusion: Does fluoride present a significant benefit by being consumed, especially in the
field and practice of dentistry?
The Risks and Benefits of Fluoride in Drinking Water McKeveny
-Yes, if the guidelines for correct fluoride dosage are followed strictly for each individual
patient.
If these guidelines are not followed, serious health concerns can result.
- More research can still be done on this topic in order to find new solutions and new methods to
fix the current problems that fluoride can present.