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This comes up in Portland periodically as we are one of the few places that DOESN'T fluoridate water.
When you do the research on it, you find some fascinating things:
Applying fluoride topically through toothpaste or mouthwash unequivocably works wonders for tooth decay.
There is no evidence drinking it as part of the water supply does ANYTHING. Positive or negative.
You have to understand one big thing... The first municipality to add fluoride to water did so in 1945.
The first fluoridated toothpaste wouldn't hit the market until 1955, 10 years later (thanks Crest!)
https://www.scientificamerican.com/article/second-thoughts-on-fluoride/
So when you look at studies trying to determine if drinking water as a source is effective, you need to immediately ignore any study done before the introduction of fluoridated toothpaste and mouthwash.
....people didn't just... stop researching fluoride after the 40s/50s. Newer studies have found less of a dramatic benefit, likely because brushing with fluoridated toothpaste is more common, but there is still a significant benefit. The countries that reduced water fluoridation and saw little to no change have universal free dental care for children.
A lot of the pushback relies on pointing out that there are diminishing returns. Multiple sources of fluoride don't seem to have compounding benefits. But that completely ignores that the goal is to raise the baseline.
Not all kids are good at brushing their teeth, not all parents care or know to put it as a priority if they're struggling. It's not going to impact virtually anyone above the poverty line, but for the people who need it most it absolutely helps.
Fluoridating water is ridiculously cheap way to add a layer of safety. A ~15-25% reduction in cavities is absolutely worth pursuing.