New, or biased, evidence on water fluoridation?

The recent review, 'New evidence on fluoridation', by Diesendorf, Colquhoun, Spittle, Everingham and Clutterbuck (Aust N Z J Public Health 1997; 21: 187-90) claims a consistent pattern of evidence pointing to fluoride damaging bone, a negligible benefit in dental caries reduction from ingested fluoride, and any small benefit from fluoride coming from the action of fluoride at the tooth surface. Public health authorities are allegedly reluctant to pursue such evidence. In the interest of scholarly debate, invited by Diesendorf et al., this reaction paper examines six separate areas raised in the original paper: fluoridation and hip fracture; fluoridation and osteosarcomas; pre-eruptive and posteruptive benefits in dental caries reduction; fluoride ingestion; benefit in dental caries reduction for contemporary Australian children; and bias of health authorities and responsible science. Numerous examples of bias in the identification, selection and appraisal of the evidence on water fluoridation presented by Diesendorf et al. are developed. Further, this reaction paper puts forward both studies and appraisal indicating that water fluoridation should continue to be regarded as a safe and effective public health measure.