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o American Cancer Society - https://www.cancer.org/cancer/cancer-causes/water- <br /> fluoridation-and-cancer-risk.html (fluoride is not associated with cancer and evidence <br /> suggests it cannot be classified as carcinogen) <br /> When evaluating possible adverse effects related to fluoride exposure it is critical to consider the <br /> dosage. It is well established that excessive consumption of fluoride can lead to alteration of mineralized <br /> tissues such as tooth enamel and bone (i.e. dental and skeletal fluorosis). Based on this knowledge it is <br /> required that communities not have a water source in excess of 4 ppm F in the drinking water as this <br /> can lead to skeletal fluorosis. Dental fluorosis occurs at a lower level of exposure with severe dental <br /> fluorosis occurring by consumption of water concentrations of 3-4 ppm F or higher in the drinking <br /> water. Multiple epidemiological studies investigating human exposure to different levels of fluoride in <br /> drinking water were used to establish a safe, yet caries reducing, dosage.2 Neither dental fluorosis nor <br /> skeletal fluorosis is a problem at the level recommended for community water fluoridation (i.e. 0.7 ppm <br /> F).3 <br /> Large epidemiological studies at the community level have assessed issues related to the health <br /> of individuals with and without water fluoridation including cancer, increased risk of chromosome <br /> damage and having children with Down syndrome, skeletal fluorosis, dental fluorosis, IQ, kidney and <br /> thyroid problems and numerous other issues. To date, these studies have failed to show, that at the <br /> currently recommended levels of water fluoridation, any of these negative health outcomes are caused <br /> by fluoride.4 The topic remains highly controversial and studies related to many of the issues raised by <br /> those opposed to community water fluoridation are ongoing. The National Toxicology Program report <br /> on IQ and diminished cognitive ability resulting from fluoride exposure concluded that there was not <br /> sufficient evidence to support an association of these conditions with fluoride exposure at the dosage <br /> levels recommended for community water fluoridation5. <br /> 16 <br />