MONTREAL — After years of obscurity, the idea of fluoridating the water supply is back.
Provincial public-health officials are pressing the Parti Québécois to retreat from its 2012 election pledge to end all fluoridation of water. The PQ government’s health minister, Réjean Hébert, favours a U-turn in principle, but he says he won’t urge municipalities to fluoridate their water unless popular opinion backs him. Public-health officials will therefore soon launch a pro-fluoride PR campaign.
Is fluoridating drinking water to reduce cavities in teeth a good idea?
It’s hard for ordinary lay people, such as myself, to know where the truth lies in this extremely controversial question. But I am sure of this: The question is complex, and the habit of many fluoride proponents to portray their critics as nitwits is uncalled for. (An op-ed piece in Wednesday’s Gazette by a Montreal cardiologist, Christopher Labos, offers an example: He lumped fluoridation critics in with the bodily-fluids nutcase in the movie Dr. Strangelove.)
This complexity was apparent the last time Montreal considered fluoridation. That was in 1987, when mayor Jean Doré sought to fluoridate and thus follow the lead of eight West Island suburbs. (They are: Baie d’Urfé, Beaconsfield, Dollard-des-Ormeaux, Dorval, Kirkland, Pointe-Claire, Ste-Anne-de-Bellevue and Senneville. All still use fluoridated water.)
When Doré submitted the proposal to a city council committee for scrutiny, everyone expected slam-dunk approval. At the committee’s public hearings, public-health officials stressed that such establishment organizations as the Canadian Dental Association, the Canadian Medical Association and the World Health Organization had endorsed the fluoridation as an effective, safe and inexpensive way to reduce tooth decay, particularly among children in low socio-economic groups (where brushing teeth might not be so common).
But then critics, including reputable environmental groups, weighed in, questioning the effect that fluoride might have when combined with polluting chemicals in our waterways. Others questioned the dental benefits. In the end, half of the committee members expressed doubts on the proposal, and Doré eventually withdrew it.
More questions have since emerged since. For example:
Because fluoride accumulates in bones, the elderly often have considerable amounts of the chemical. In 2006, the U.S. National Academies of Science’s 12-member Committee on Fluoride in Drinking Water concluded, “Overall, there was consensus that there is scientific evidence that under certain conditions fluoride can weaken the bones and increase the risk of fracture.” Given the aging of the population, this possibility could be of growing importance.
The American Dental Association’s claim that fluoride can cut cavities by 20 to 40 per cent also faces increased challenge. Because more than three out of four Ontarians live in areas using fluoridated water, in contrast to about one in 20 Quebecers, one might assume that Ontario youths would have far fewer cavities than their Quebec peers. In 2010, however, a Statistics Canada breakdown of cavity rates showed that the difference in the 6-11 age group was minimal: Ontario children averaged 1.7 cavities compared with 1.76 among Quebecers. In the 12-19 age bracket, Ontarians averaged 2.35 cavities versus Quebecers’ 2.79. Widespread use of fluoridated toothpaste could help explain the narrow gap.
Adverse though such research might be, it has failed to convince Quebec’s health minister or the dental associations. Thus the American Dental Association’s Fluoridation Facts guide insists: “The ingestion of optimally fluoridated water does not have an adverse effect on bone health.”
Although I’m unqualified to wade through the esoteric scientific claims and counter-claims and form a judgment, I do find one critique of fluoridation strikingly impressive. It has little to do with science but a lot to do with a sense of proportion.
At those 1980s hearings at city hall, the group representing Quebec’s water technicians said people would drink only eight of the 4,000 tonnes of fluoride with which Doré proposed to lace Montreal’s drinking water every year. That’s because people swallow just 0.25 per cent of the 800 litres of water produced daily per capita. “That means,” testified the Association québécoise des techniques de l’eau, “that 99.7 per cent of the fluoride would not be ingested by residents but will find its way into the environment.” The proportion can’t have changed significantly over the decades.
Note that this 99.7-per-cent figure actually might well be on the low side. That’s because fluoridation is primarily for a) children and teens, who represent only one-fifth of the city’s water consumers, and b) more particularly those children and teens who live in low-income areas, which further shrinks the number of prime beneficiaries. These considerations mean that as much as 99.9 per cent of the water might not reach the target population.
That’s hardly an efficient medication-delivery system.
There’s got to be a better way. Maybe the province could distribute toothbrushes and fluoridated toothpaste in schools located in low-income areas. Maybe Quebec could follow the example of France, Germany, Switzerland and several other European countries and fluoridate table salt instead of water.
When Quebec public-health officials try to persuade you that fluoridated water is the surefire way to go, skepticism is in order.
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