Before New Tecumseth councillors carry out a final vote on whether or not to fluoridate Tottenham’s drinking water, I would like to provide my expert opinion.
I served 3.5 years on the US National Academies of Sciences Subcommittee on Fluoride in Drinking Water (also called the NRC Committee). The NAS is sometimes referred to as the ‘Supreme Court of Science’, an organization that sets up unbiased (or balanced) committees to review scientific issues of concern to Americans. The committee on which I served examined the health effects of fluoride in drinking water. Our report was published March 22, 2006 and can be found online at http://www.nap.edu/catalog.php?record_id=11571
Our committee was funded by the US Environmental Protection Agency (EPA). We reviewed all relevant literature on the toxicity of fluoride, including properly conducted, peer review studies at low levels of intake, and the effects of fluoridation.
I am also the co-author of studies that show that too much fluoride accumulation in the dentin of teeth (the tissue that supports enamel) causes the physical properties of the tooth to change as well, such as making the dentin more brittle and increasing its susceptibility to dental decay.
Fluoridation has not been shown to be safe and effective. In fact, as more and more peer-reviewed studies on fluoride toxicity appear in the literature, it has become clear that the pendulum is certainly shifting to ‘not safe, and no longer effective.’
As a practicing dentist, I have been diagnosing and treating patients with dental fluorosis for close to 20 years. My research on dental fluorosis (confirmed by the studies reported in the 2006 NRC report as well as the York review) shows that fluoridation significantly increases the numbers of patients seeking expensive cosmetic repairs. No one in public health has ever accounted for the added costs in treating dental fluorosis when considering the cost-benefit ratio of fluoridation.
I think Tottenham should join the many cities across Canada that have elected to stop fluoridation. I feel that fluoridation is no longer a policy that should be supported.
(Below) is my critique of the presentation made by Simcoe Muskoka Chief Medical Officer of Health Dr. Charles Gardner, to New Tecumseth council on Sept. 23, 2013.
In his presentation Dr. Gardner presented this slide.
Tottenham’s low rate of child dental decay
There are many problems with this information:
1. This is the result of an unscientific survey.
2. To have any scientific meaning, the subject selection has to be randomized
and the examiners calibrated and blinded. The statistician should also be
3. Using DMFT is a very gross method of dental decay measurement: that
measurement has severe limitations and flaws.
4. Confounding factors should be considered. For example, low socioeconomic status has more to do with dental decay rates than fluoridated water status.
According to another graph Dr. Gardner presented, there is a 0.3 DMFT difference between Tottenham (fluoridated) and non—fluoridated New Tecumseth. The population of Tottenham is about 4,700. http://www.citypopulation.de/php/canada-ua-ontario.php?cityid=945
There are maybe 100 children in grades kindergarten and 2. However, one would have to have a sample size over 300 in each arm of the study (total 600) in order to do a proper study to achieve results with more confidence. I doubt the ‘study’ would pass the test of peer-review and will likely not be published. Furthermore, a 0.3 DMFT difference is clinically insignificant.
Dr. Gerry Ross claims to be able to tell where the child grew up based on the appearance of the dentition implying he can tell who was exposed to fluoridated water and who wasn’t. His is clearly an ‘anecdotal observation’ and hardly unbiased since he helped bring fluoridation to Tottenham in the first place.
Dr. Dick Ito, Simcoe Muskoka public health dental consultant, who also presented to New Tecumseth councillors, recently carried out a properly conducted study (making the necessary adjustments for some confounding factors) looking at the decay rates and fluorosis rates of fluoridated Brampton versus non-fluoridated Caledon. He found no benefit of fluoridation in Brampton.
“The effect of fluoridation on caries in these communities was not evident given the matching of the fluoridated Brampton schools to the higher SES of Caledon schools plus the variable exposure to fluoridation within the communities.” – Ito (Abstract) Caledon and Brampton Study, Peel Region 2001-2002, 2007 Ito (Webpage Abstract) Caledon and Brampton Study, Peel Region 2001-2002, 2007
ENTIRE STUDY: Dick Ito DDS, A Cross-Sectional Study To Compare Caries And Fluorosis In 7-Year-Old Schoolchildren From A Fluoridated Area With Those In A Neighbouring Non-Fluoridated Area In Ontario, MSc Thesis, U. Of Toronto, 2007
A while ago, Dr. David Locker, a former professor of public health dentistry at my Faculty (now deceased), was commissioned by the Ontario Ministry of Health to review fluoridation in Canada and he concluded: “Although current studies of the effectiveness of water fluoridation have design weaknesses and methodological flaws, the balance of evidence suggests that rates of dental decay are lower in fluoridated than non-fluoridated communities. The magnitude of the effect is not large in absolute terms, is often not statistically significant and may not be of clinical significance.” Locker et al, Benefits And Risks Of Water Fluoridation Ð Report To Ontario Ministry Of Health & Health Canada 15-Nov-1999
It is important to realize that Dr. Locker’s report was instrumental in influencing government agencies to lower the recommended fluoride levels in Ontario’s drinking water.
Most experts worldwide now believe that many other factors have contributed to the lowering of dental decay rates in industrialized countries.
Regarding dental fluorosis, Dr. Gardner is also misleading the good people of Tottenham. In this slide he claims that dental fluorosis from fluoridation is not a problem.
Dr. Ito also found that the one in every 10th child in the fluoridated community had objectionable fluorosis. Dr. Gardner may not consider this a health concern, but believe me, my patients (I practice in Mississauga) with objectionable fluorosis consider this irreversible ‘scarring’ of the teeth just as serious as severe acne that leaves pock marks on their faces. The research confirms that fluorosis is as harmful to patients’ self-confidence as severe dental decay or severe dental crowding.
In the following slide, Dr. Gardner tries to assure people that fluoride at the Maximum acceptable level (MAC) of 1.5 mg/L is perfectly safe and that “research does not support a link between exposure to fluoride in drinking water at 1.5 ppm and any adverse health effects,”
Be careful of absolute statements (e.g. no link to ANY study of harm?) made by the people who want you to continue to fluoridate. They cannot guarantee safety and efficacy.
The MAC is set at 1.5 ppm for a reason. At that level all kinds of adverse health effects occur. We documented these in our NRC review. Several studies, especially the Bassin study, which was NOT refuted by the other studies mentioned in the slide, indicate that fluoride likely promotes bone cancer. Our NCR Report (2006) said as much.
Finally Dr. Gardner said “Every $1 invested in community water fluoridation yields about $38 in savings each year from fewer cavities treated.” How is this possible?
Ask the water plant managers what the total cost is for fluoridation each year per person, including the cost of chemicals, their safe handling and disposal, maintenance and replacement of fluoridation equipment, water chemistry analysis, personnel training and salaries, insurance, etc. A conservative estimate for the cost of fluoridating small towns is $3 per person per year based on several publications.
After 50 years of fluoridation, then, $150 per person will have been spent on fluoridation. That, according to the claim, would save $150 X 38 =$5,700 in dental costs per person during that time. But the research shows that MAYBE one filling is saved per person over a lifetime.
For example the most recent published study with sufficient subjects showed that a lifetime of fluoridation significantly reduced dental decay but the benefit in actual fillings was only one filling over a lifetime of fluoridation. Fillings don’t cost $5,700 each. Clearly the $1 saves $38 statement is a huge exaggeration.
In my opinion, the statement “Every $1 invested in community water fluoridation yields about $38 in savings each year from fewer cavities treated.” is not only a gross misinterpretation of the literature but, as worded, is a bold lie.
The people of Tottenham will likely have to decide whether to trust the information provided by the public health officials and the medical officers of health, but many countries worldwide have long abandoned fluoridation because it is ineffective, unsafe and unethical.
Cities in Canada are also abandoning the practice. The most recent are cities like Quebec City, Waterloo, Calgary and Windsor. Those cities finally decided to stop wasting their money on toxic waste (fluoridation chemicals) that not only are no longer effective to prevent decay but are likely harmful to humans and the environment.
By Dr. Hardy Limeback BSc PhD (Biochemistry) DDS
Professor Emeritus and former Head, Preventive Dentistry
Faculty of Dentistry, University of Toronto