The following is a rebuttal to a column by Licia Corbella,
“The science is not settled on water fluoridation,” which
appeared in the Herald on Oct. 12. The original piece
appears below this response.
As the newly elected Calgary city councillors take their seats, an important public health issue awaits. Children and other residents are suffering because of the 2011 decision to cease fluoridating the water.
Public health officials strongly recommend that Calgary resume this safe and effective practice.
Calgarians approved fluoridation twice, in plebiscites in 1989 and 1998. From 1991 to 2011, Calgarians enjoyed fluoridation’s benefits until some city councillors and a journalist, apparently animated by a U.S. based anti-fluoridation group, significantly misinformed the public and city councillors.
Without having campaigned on the issue, 10 city councillors suddenly removed what 114,105 citizens had approved. This action was anti-democratic.
The decision was ill-considered because fluoridation is safe. The decision was harmful because fluoride is 26 to 44 per cent effective in reducing cavities.
More than 3,000 peer-reviewed studies demonstrate that fluoridation is effective and support its safety. Fluoridation is recommended by Alberta Health Services, Health Canada, the Canadian Dental Association, the Centers for Disease Control and Prevention, the World Health Organization and the leading national and international dental and medical organizations.
How likely is it that public health, dental and medical organizations are all wrong? The highly qualified people who staff and support these organizations work independently and have developed their considered conclusions after following rigorous scientific protocols for their studies, including peer review and publication.
Those advocating for fluoridation are not in conflict of interest; they are focused on the public interest. By contrast, some bottled water companies encourage the false belief that tap water is unsafe to benefit financially from the fear they create.
Fluoridation has been used for 70 years and none of the claimed harms have materialized, despite mischaracterizations of studies irrelevant to North America and conducted in Mexico and in China, where lead and arsenic also occur in their water.
The arguments advanced against fluoridation are weak. First, it is false to claim that fluoridation at 0.7 parts per million is unsafe and ineffective. We call upon all journalists to base all fluoridation commentary on the facts: fluoride is safe and effective.
A second poor argument is that fluoridation is mass medication. Fluoride is no more a medication than calcium is a medication. Fluoride is a mineral. Fluoride occurs naturally in Calgary water at concentrations of 0.1 to 0.4 parts per million. Fluoridation merely entails topping it up to 0.7 parts per million, which is therapeutic.
If fluoride were really so harmful, then why aren’t opponents demanding that Calgary eliminate this naturally occurring mineral from our water? There is no difference between the fluoride ion that naturally exists in the water and the one that is added. Adjusting fluoride levels in community water is akin to adding iodine to salt, vitamin D to milk and vitamin B to bread and cereal.
A third argument accepts that fluoridation is a public good, but claims that Calgary should not pay for it — the province should. But the taxes that fund provinces and cities come from taxpayers. Fluoridation in every North American city is a municipal preventative health measure — just as chlorination, streetlights and crosswalks are preventative health measures.
The cost of fluoridation is relatively small – between $5 million and $10 million for equipment and $750,000 for the annual operating costs, which amounts to 60 cents per person per year. Capital costs can be amortized, and several studies have proven that every $1 invested in fluoridation yields approximately $38 to $60 savings in treatment costs. Fluoridation is demonstrated to be cost effective.
The real question is: Why do Calgarians let a few unqualified people who misrepresent the scientific evidence, prevent Calgary children, seniors and others from having the same good oral health that people enjoy in Toronto, New York, Chicago, Los Angeles and Miami, to name just a few cities? Why isn’t Calgary like the 87 per cent of NHL home cities that use fluoridation?
Calgary dentists and orthodontists are distressed by the significant changes they are seeing. Dental cavities did not occur as often or grow with such speed when the water was fluoridated. Now things are much worse. Ask any anaesthesiologist at the Children’s Hospital, where a long waiting list now exists for children’s dental care under general anaesthetic.
The solution is not to build more operating rooms with dental instruments. Calgarians voted twice for fluoridation. It is time to honour democracy and to reduce the avoidable pain and suffering of Calgarians. We call upon city councillors to make the reinstatement of fluoridation their first priority.
- Juliet Guichon SJD, Calgarians for Kids’ Health
- Jon Meddings, MD, FRCPC, Dean, Cumming School of Medicine, University of Calgary
- Paul Allison, BDS, FDSRCS(Eng), MSc, PhD, President, Association of Canadian Faculties of Dentistry; Dean, Faculty of Dentistry, McGill University
- Mintoo Basahti, President, Alberta Dental Association and College
- Douglas Brothwell, DMD, DDPH, MSc, Dean, College of Dentistry, University of Saskatchewan
- Blaine M Cleghorn, DMD MS, Professor, Assistant Dean, Clinics, Faculty of Dentistry, Dalhousie University
- Gerry Uswak, DMD, MPH, Acting Director Clinics & Community Programs; Former Dean, College of Dentistry, University of Saskatchewan
- Ferne Kraglund, DDS, MSc, FRCD(C), Assistant Dean for Student Affairs, Faculty of Dentistry, Dalhousie University
- Mintoo Basahti, President, Alberta Dental Association and College
- Allison McGeer, M.D., FRCPC, Microbiologist, Infectious Disease Consultant, Department of Microbiology, Mount Sinai Hospital
- Shahrokh Esfandiari, BSc, DMD, MSc, PhD, Post-Doc, FICOI, FITI, Associate Professor, Faculty of Dentistry, Division of Oral Health and Society, McGill University
- Jocelyne Feine, Professor, Oral Health and Society Division, Faculty of Dentistry; Professor, Faculty of Medicine, McGill University
- Ernest Lam, B.Sc. (HONS.), D.M.D., M.Sc., CERT. O.M.R., Ph.D., DIP., A.B.O.M.R., F.R.D. (C), Professor, Faculty of Dentistry, University of Toronto
- C. Tenenbaum, DDS, Dip. Perio., PhD, FRCD(C), Dentist-in-Chief, Sinai Health System; Professor of Periodontology, Faculty of Dentistry; Professor of Laboratory Medicine and Pathobiology, Faculty of Medicine, Mount Sinai Hospital, University of Toronto;
- Michael J. Sigal, DDS, MSc, Dip Ped, FRCD (C), Professor Pediatric Dentistry Past Head Pediatric Dentistry and Past Director Graduate Program, University of Toronto
- James A Dickinson MBBS PhD CCFP FRACGP Professor of Family Medicine and Community Health Sciences U Calgary.
- Hazel Stewart, Director, Dental and Oral Health Services, Toronto Public Health
- Wendy Wadey, DDS, General Practitioner of Dentistry, Calgary
- June Dabbagh, DDS, General Practitioner of Dentistry, Calgary
- Laurie Houston, DDS, General Practitioner of Dentistry, Calgary
- Larry Stanleigh, BSc, MSc, DDS, FADI, FICD, FACD, FPFA, General Practitioner of Dentistry, Calgary
- Angela Demeter, BSc, DDS, MSc, Dip Perio, FRCD(C), Periodontist
The science is not settled on water fluoridation
By Licia Corbella
Edmonton has fluoride in its drinking water. Calgary does not. Take a wild guess which of the two cities’children have more cavities? If you said Calgary, you’d be wrong! Chew on that for a while. Despite continuing to have fluoride in their water, kids in Edmonton have more tooth decay than Calgary kids, in their baby teeth and their permanent teeth, says a University of Calgary study.
But, how can that be? Isn’t fluoride the wonder supplement that’s supposed to mean little kids will suffer less tooth decay? That’s what many proponents of adding fluoride to our drinking water would have you believe. They have also urged people to base their position on fluoridated water on scientific data. Finally, something we can agree on! A 2016 U of C study called Measuring the short-term impact of fluoridation cessation on dental caries in Grade 2 children using tooth surface indices shows that fluoride isn’t all that it’s cracked up to be.
You might have guessed by the above title, that this study isn’t exactly a page turner. You also might recall news coverage on this report. Pretty much the only thing mentioned in the past about this study was how there was an increase in primary tooth decay in both Edmonton and Calgary but “the magnitude of the increase was greater in Calgary” following the cessation of fluoride. What’s curious is why reporting on the study stopped there.
What was not widely published is that according to the very same study, the number of cavities in permanent teeth actually decreased in Calgary since fluoridation ended. You read that correctly.
“For all tooth surfaces among permanent teeth, there was a statistically significant decrease in Calgary … which was not observed in Edmonton.” Interesting, isn’t it, that this juicy morsel from the report was never quoted? So, let’s recap that last paragraph. Since May 2011, when fluoride was removed from Calgary’s drinking water but has remained in Edmonton’s water since 1967, there has been a “statistically significant decrease in Calgary” for all tooth surfaces among permanent teeth but the same decrease did not occur in Edmonton. Drink that in slowly.
Consider the following conclusion: “In permanent teeth, we elsewhere (in unpublished results) reported a decrease in caries over time in both Calgary (fluoride cessation) and Edmonton (fluoride continued), which was larger and more consistent in Calgary.” The rate of improvement was better in Calgary than Edmonton.
Yet there are those who want Calgarians heading to the polls on Oct. 16 to elect only candidates who will put fluoridation back on tap in Calgary. The group Calgarians for Kids’Health presented anecdotal evidence of kids with tooth decay on Sept. 25, that included presenting a mother who said: “I have a fourand-a-half-year-old here and her teeth are falling out because she didn’t get fluoride from the day she was born.”
There is no reason why a young child’s teeth should be falling out unless poor diet, disease, or a lack of dental care exists.
The reason fluoride was removed from Calgary’s drinking water in 2011 was because council was being asked to upgrade the fluoride-adding equipment at Calgary’s Glenmore and Bearspaw water treatment facilities – something that was expected to cost between $3 million to $6 million. In addition, the city spent $750,000 annually in operational costs. The debate ensued and freedom of choice to not be medicated through our water supply was rightly chosen by most of council.
Alberta Liberal MLA Dr. David Swann said recently that he’s “deeply disappointed by the level of misinformation and fearmongering surrounding fluoridation. It flies in the face of 35 years of research that fluoride water treatment is a safe and effective way to protect our dental health.”
Swann and other proponents of fluoridation are trying to claim that the science is settled. But if you actually read recent studies about fluoridation, you will see that’s not the case. A very recent University of Toronto study is linking fluoride exposure in pregnant women to lower intelligence in their children. Another meta analysis from 2012 shows 27 other reports pointing to the same potential results.
If the science has been settled for 35 years, as Swann claims, why did medical experts recommend that fluoride in Calgary’s water and across North America be reduced from one part per million to 0.7 ppm in 1998? Why in 2006 did the American Dental Association recommend that parents not prepare baby formula with fluoridated water, something that the Centers for Disease Control still recommends?
How can a scientist insist on medicating people when it’s impossible to regulate the dose? “Collectively, the literature (including our study) indicates that the impact of fluoridation cessation on dental caries is not uniformly positive or negative, but varies by time and place and sorting out the reasons for different patterns is important,” states the U of C study.
Ingesting fluoride, rather than having it topically painted or swished around teeth, has been linked to other negative health effects, including impacts to the thyroid, kidneys or bones. It’s not fearmongering.
I used to be one of those dismissive proponents of fluoride until my position was ripped out by the root when I realized fluoridated water harmed my children.
Many Calgarians, including my sons, have evidence of fluorosis on their teeth. It’s evident every time they smile and that makes me frown. Those chalky white blotches and streaks on their teeth are not just cosmetic. It means that their bones have been affected after fluoride was literally forced down our throats.
*Original article online at http://calgaryherald.com/opinion/columnists/opinion-fluoridation-should-be-city-councils-top-priority