By Meredith Lauzon, Dylan Parobec, and Daanish Rehman<\/strong><\/p>\n [\/et_pb_fullwidth_header][\/et_pb_section][et_pb_section fb_built=”1″ _builder_version=”3.21″ custom_padding=”0|0px|0|0px|false|false”][et_pb_row _builder_version=”3.21″][et_pb_column type=”4_4″ _builder_version=”3.21″][et_pb_testimonial author=”\u2013 Lindsay McLaren” job_title=”Associate Professor at Department of Community Health Sciences and the O’Brien Institute for Public Health” company_name=”University of Calgary ” _builder_version=”3.21″]<\/p>\n [\/et_pb_testimonial][\/et_pb_column][\/et_pb_row][\/et_pb_section][et_pb_section fb_built=”1″ _builder_version=”3.21″ custom_padding=”0|0px|0|0px|false|false”][et_pb_row custom_padding=”0|0px|0|0px|false|false” _builder_version=”3.21″][et_pb_column type=”4_4″ _builder_version=”3.21″][et_pb_text _builder_version=”3.21″]<\/p>\n Fluoride isn\u2019t just found in your toothpaste; it might also be in your water. In Ottawa, it\u2019s step eight on the city\u2019s <\/span>ten-step water treatment<\/a> process, added to protect the public from the common affliction, cavities.<\/span><\/p>\n <\/span><\/p>\n Yet not everyone is convinced the chemical should be part of the public water supply. Fluoride\u2019s presence in Canadian drinking water has waxed and waned over the past few decades\u2013sometimes because of the cost of fluoridation, sometimes due to fears about its health effects\u2014fears that are unsubstantiated, according to Health Canada. Fluoridation is an \u201c<\/span>important and often overlooked public health measure<\/span><\/a>,\u201d and it remains the \u201c<\/span>most cost-effective and equitable<\/span><\/a>\u201d way to prevent cavities on a population level, the agency notes on its website. But the controversy hasn\u2019t ebbed. In the wake of fluoride removal from some Canadian municipal water supplies over the past decade, new public health research <\/span>suggests cavities are on the rise <\/span>\u00a0– motivating officials in some cities without fluoride to rethink its elimination.<\/span><\/p>\n [\/et_pb_text][\/et_pb_column][\/et_pb_row][\/et_pb_section][et_pb_section fb_built=”1″ _builder_version=”3.21″ custom_padding=”0|0px|0|0px|false|false”][et_pb_row custom_padding=”27px|0px|0|0px|false|false” _builder_version=”3.21″][et_pb_column type=”2_3″ _builder_version=”3.21″][et_pb_text _builder_version=”3.21″ header_font=”||||||||” header_3_font=”||||||||” header_3_text_color=”#d37400″]<\/p>\n In Canada, fluoridation of public water began in Brantford, Ontario in 1945. Community water fluoridation hit a country-wide peak <\/span>in 2007 at 42 per cent<\/span><\/a>. Health Canada regulates the optimal level of fluoride in water at 0.7 milligrams\/liter, a measure Public Health Agency of Canada attributes to a 25 to 30 per cent reduction in tooth decay.<\/span><\/p>\n <\/span><\/p>\n But over the past decade, the practice has waned. The <\/span>most recent survey<\/span><\/a> by the Public Health Agency of Canada, performed in 2017, showed fluoridation levels at 39 per cent across the country. The drop comes as municipalities across the country began discontinuing fluoridation, with the largest change happening in Alberta. In that province, the practice dropped from 74 per cent in 2007 to 43 per cent in 2012, <\/span>where it remains today<\/span><\/a>. This plunge is largely due to Calgary\u2019s removal of fluoride from their water after which other municipalities in the province followed suit.<\/span><\/p>\n <\/span><\/p>\n [\/et_pb_text][\/et_pb_column][et_pb_column type=”1_3″ _builder_version=”3.21″][et_pb_image src=”https:\/\/cusjc.ca\/catalyst\/wp-content\/uploads\/2019\/04\/nhia-moua-719016-unsplash-1.jpg” _builder_version=”3.21″][\/et_pb_image][et_pb_text _builder_version=”3.21″ text_font=”|300|||||||” header_font=”|300|||||||” header_font_size=”23px” custom_margin=”-27px||”]<\/p>\n Photo by\u00a0<\/span>Nhia Moua<\/a>\u00a0on\u00a0<\/span>Unsplash<\/a>.<\/p>\n [\/et_pb_text][\/et_pb_column][\/et_pb_row][et_pb_row custom_padding=”3px|0px|3px|0px|false|false” _builder_version=”3.21″][et_pb_column type=”4_4″ _builder_version=”3.21″][et_pb_text _builder_version=”3.21″]<\/p>\n <\/span><\/p>\n In late February, Calgary city council broke from their previous stance and <\/span>motioned to review fluoridation research<\/span><\/a>. The move was motivated by public health researcher Lindsay McLaren and her colleagues at the University of Calgary who found a correlation between removal of fluoride and an increase of cavities in the city\u2019s children.<\/span><\/p>\n McLaren has spent eight years studying fluoridation, starting when Calgary removed it in 2011.<\/span><\/p>\n <\/span><\/p>\n She said the decision to remove fluoride from Calgary\u2019s water was partially motivated by the arguments of anti-fluoride advocates, and for financial and social reasons particular to Calgary. In addition to the<\/span> yearly operational costs of fluoridation of about $750,000,<\/span><\/a> the city\u2019s infrastructure required a $6 million upgrade, McLaren said. In 2010 there was a municipal election that led to council turnover. When a motion was brought forth to stop fluoridation as a way to reduce costs and because of concerns with its safety, it was accepted. The motion included a <\/span>resolution to redirect the funds saved<\/span><\/a> from halting fluoridation to dental care for low-income children. It is unclear whether that plan was put in place and\/or whether it helped on a large scale because of the <\/span>increasing demands for dental care for disadvantaged families<\/span><\/a> in Calgary. To some, this decision is surprising, but not to McLaren. She said Alberta\u2019s largest city only adopted the fluoridation in 1991, and never had strong public support for the practice.<\/span><\/p>\n [\/et_pb_text][\/et_pb_column][\/et_pb_row][et_pb_row custom_padding=”33px|0px|0|0px|false|false” _builder_version=”3.21″][et_pb_column type=”4_4″ _builder_version=”3.21″][et_pb_text _builder_version=”3.21″ header_font=”||||||||” header_3_font=”||||||||” header_3_text_color=”#d37400″]<\/p>\n In February 2019, the Canadian Agency for Drugs and Technologies in Health, an independent, not-for-profit agency that conducts systemic analyses of issues in health care published a report on the possible health outcomes of municipal water fluoridation in Canada.<\/span><\/p>\n <\/span><\/p>\n Examining six decades of data, the organization <\/span>found no evidence or insufficient evidence to associate fluoridation with poor health outcomes<\/span><\/a>. In particular, the report found \u201cno association between water fluoridation at the current Canadian levels and bone cancer, total cancer incidence, hip fracture, Down syndrome, and IQ and cognitive function.\u201d Other systemic analyses come to similar conclusions: Australia\u2019s National Health and Medical Research Council found that \u201cwater fluoridation is safe and effective in helping to prevent tooth decay in the ranges recommended for use across Australia\u201d and \u201c<\/span>does not cause harm<\/span><\/a>.\u201d<\/span><\/p>\n [\/et_pb_text][\/et_pb_column][\/et_pb_row][et_pb_row custom_padding=”0|0px|0|0px|false|false” _builder_version=”3.21″][et_pb_column type=”2_5″ _builder_version=”3.21″][et_pb_text _builder_version=”3.21″]<\/p>\n <\/span><\/p>\n Such reports have done little to dampen the energy of anti-fluoridation lobbyists.<\/span><\/span><\/p>\n <\/span><\/p>\n One of the most prominent voices in opposition of public water fluoridation is Paul Connett, the acting director and co-founder of Fluoridation Action Network (FAN), located in Binghamton, New York.<\/span><\/span><\/p>\n <\/span><\/p>\n \u201cFrom a scientific point of view no one has ever demonstrated that we need fluoride as a nutrient,\u201d said Connett. \u201cThe one tissue that may benefit from topical fluoride is the teeth, but this is a topical mechanism, it reacts on the surface of the tooth, not from inside the body.\u201d<\/span><\/p>\n<\/blockquote>\n <\/span><\/p>\n Connett said he is concerned about the biological effects that fluoride might have when ingested in the water supply. He points to a 2017 study that examined fluoride exposure on prenatal and childhood neural development in Mexico, the work of University of Toronto researcher Howard Hu and colleagues.<\/span><\/p>\n <\/span><\/p>\n The study, published in Environmental Health Perspectives, found that among 299 mother and baby pairs in Mexico,\u00a0\u201chigher prenatal fluoride exposure was associated with lower scores on tests of cognitive function in the offspring.\u201d<\/a><\/span><\/p>\n When the study was published, the study\u2019s main author Hu told National Post that\u00a0\u201cthere still may be a level of fluoride exposure among both pregnant women and everybody else that can still preserve the beneficial effects on tooth decay, while avoiding any effects on intelligence.\u201d<\/a><\/span><\/span><\/p>\n <\/span><\/p>\n <\/span><\/p>\n [\/et_pb_text][\/et_pb_column][et_pb_column type=”3_5″ _builder_version=”3.21″][et_pb_text _builder_version=”3.21″][\/et_pb_text][et_pb_text _builder_version=”3.21″][\/et_pb_text][et_pb_image src=”https:\/\/cusjc.ca\/catalyst\/wp-content\/uploads\/2019\/04\/POSTER-FINAL-FINAL-FINAL.jpg” _builder_version=”3.21″][\/et_pb_image][et_pb_text _builder_version=”3.21″ text_font=”|300|||||||” custom_margin=”-27px||-21px” custom_padding=”0px||”]<\/p>\n Data visualization by Daanish Rehman<\/p>\n Data source: Community Water Fluoridation presentation by Dr. Khalida Hai-Santiago, DMD, Oral Health Consultant\u00a0http:\/\/www.wrha.mb.ca\/healthinfo\/preventill\/files\/HSHC-Presentation-02.pdf?fbclid=IwAR1MrGyEh54YiUdbb5B_yskFK9_gEZRrEUsPG3JHdCHglVWepZPz2xJoZdM<\/a><\/p>\n <\/p>\n [\/et_pb_text][\/et_pb_column][\/et_pb_row][et_pb_row custom_padding=”0|0px|0|0px|false|false” _builder_version=”3.21″][et_pb_column type=”4_4″ _builder_version=”3.21″][et_pb_text _builder_version=”3.21″]<\/p>\n In an email to Catalyst, Hu added that more research needs to be conducted on the long-term effects of fluoridation exposure, but that he\u2019d prefer to “let debaters and policy makers conduct the discourse.\u201d<\/span><\/p>\n [\/et_pb_text][\/et_pb_column][\/et_pb_row][et_pb_row custom_padding=”0|0px|0|0px|false|false” _builder_version=”3.21″][et_pb_column type=”4_4″ _builder_version=”3.21″][et_pb_text _builder_version=”3.21″]<\/p>\n Public health researcher McLaren said Hu\u2019s paper and others are \u201cimportant, peer-reviewed contributions to this field.\u201d She adds that research isn\u2019t static\u2013it\u2019s important to continue researching to be able to recommend the best public health options that consider all potential benefits and harms.<\/span><\/p>\n<\/blockquote>\n <\/span><\/p>\n In that regard, systematic reviews of all available studies are important for informing public policy. Systematic studies, McLaren said, gather all the individual studies together, assess methodological strengths and weaknesses, and evaluate overall relevance. \u201cFor example, sometimes studies focus on levels of fluoride that are very high, which would not necessarily be relevant to community water fluoridation per se.\u201d<\/span><\/p>\n <\/span><\/p>\n At the levels Health Canada recommends, McLaren does point out that fluoride can occasionally cause a cosmetic condition\u2013discolored patches on teeth. This condition, called dental fluorosis, might be considered an adverse outcome because people\u2019s appearance affects their wellbeing, said McLaren. But she said there is no robust research to suggest that there are other adverse health outcomes at the recommended level of fluoride in Canadian drinking water.<\/span><\/p>\n <\/span><\/p>\n <\/span><\/p>\n [\/et_pb_text][\/et_pb_column][\/et_pb_row][et_pb_row custom_padding=”2px|0px|0|0px|false|false” _builder_version=”3.21″][et_pb_column type=”4_4″ _builder_version=”3.21″][et_pb_text _builder_version=”3.21″ header_font=”||||||||” header_3_font=”||||||||” header_3_text_color=”#d37400″]<\/p>\n Fluoridation prevents tooth decay in three ways, McLaren said. It enhances tooth remineralization by building up the protective enamel on teeth, it prevents or slows down the process of tooth demineralization, and consuming it through fluoridated water means that there is a low level of fluoride in your saliva, which helps fight the bacteria causing tooth decay.<\/span><\/p>\n <\/span><\/p>\n The bacteria that cause cavities disrupt the tooth\u2019s structure, causing weak spots, explained Ottawa dentist, Dr. Asal Hashemi. Fluoride helps strengthen those weak spots to prevent them from worsening in to cavities. Once a cavity is formed, fluoride cannot undo this decay and dental intervention is necessary \u2013 and is often costly.<\/span><\/p>\n [\/et_pb_text][\/et_pb_column][\/et_pb_row][et_pb_row custom_padding=”0|0|0|0px|false|false” _builder_version=”3.21″][et_pb_column type=”1_4″ _builder_version=”3.21″][et_pb_text _builder_version=”3.21″]<\/p>\n <\/span><\/p>\n <\/span><\/p>\n In Canada, only \u201cmedically necessary\u201d dental surgery is covered by universal health insurance plans. <\/span>This does not include preventative visits like fluoride services or cleanings<\/span><\/a>. <\/span><\/p>\n <\/span><\/p>\n In a<\/span> study on the Canadian dental system<\/span><\/a> published by the C.D Howe Institute, Carleton University public policy researcher Frances Woolley found that, \u201cdental problems are strongly correlated with income.\u201d <\/span><\/p>\n <\/span><\/p>\n Although all provinces have some dental programs for low income individuals<\/span><\/a>, the coverage is often patchy. <\/span>Cavities can take months to a year to manifest<\/span><\/a>, and depending on the province, \u00a0the available programs for low income recipients may only provide coverage assistance after major dental problems have developed, as shown by the C.D. Howe Institute.<\/span><\/p>\n <\/span><\/p>\n For comprehensive coverage, people typically rely on employer-based dental programs that are often only available to full-time employees. This poses a concern for those in the \u201cgig economy\u201d that do not receive benefits, and the soon-retiring baby-boom generation, the C.D Howe study indicates.<\/span><\/p>\n <\/span><\/p>\n [\/et_pb_text][\/et_pb_column][et_pb_column type=”3_4″ _builder_version=”3.21″][et_pb_code _builder_version=”3.21″]<\/p>\n\n
“I never would have envisioned [fluoridation research] would lead to this many questions that I felt needed to be answered.”<\/span><\/em><\/h1>\n<\/blockquote>\n
Fluoridation\u2019s Canadian History<\/h3>\n
Fluoridation and Health<\/h3>\n
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Fluoridation and Dental Care Coverage in Canada<\/h3>\n
