“Are you in favour of reintroducing fluoridation of the municipal water supply?”

Calgarians have been battling over fluoridation for more than six decades.

After rejecting it four times (in 1957, 1961, 1966 and 1971), voters approved fluoridation in a 1989 plebiscite, and reaffirmed that choice in 1999. In 2011, council unilaterally ended fluoridation of Calgary’s drinking water, opting not to hold a plebiscite.

This year’s vote is not binding on council.

Fluoridation has been described as one of the greatest public health achievements of the 20th century. Tooth decay is an ancient human disease, but its prevalence spiked sharply after the Industrial Revolution made refined sugar cheap and available to the masses. Prior to the discovery of fluoride’s decay-prevention properties around the turn of the 20th century, and the beginning of community water fluoridation in North America in the 1940s, tooth decay was widespread and usually treated by extraction.

We increasingly keep the majority of our teeth for a lifetime, and fluoride is a major reason why. Between 1970 and 2007, the percentage of Canadian adults with no natural teeth dropped from 23.6% to 6.4%.

But dental caries (or cavities) are still a major public health concern in Canada, correlated with factors like race and socioeconomic status. Community water fluoridation, proponents argue, is one effective, safe and relatively inexpensive way to provide a basic degree of dental protection to an entire population.

Arguments against fluoridation are varied, with differing degrees of legitimacy. Its introduction coincided with the beginning of the Cold War, and a far-right conspiracy theory that fluoridation was a Communist plot was parodied in the 1964 film Dr. Strangelove.

Today, critics raise concerns about the effects of fluoridated water combined with fluoridated toothpaste, or that people consume different amounts of water, or that the money could be better spent on targeted dental programs. Others cite discredited or misrepresented research. One argument popular in libertarian-friendly Alberta is consent and freedom of choice. Then there are those whose distrust of science is reminiscent of anti-vaccine propaganda.

Decades of study on fluoridation have established its general effectiveness and safety, though the recommended amount has been revised downward. In 2012, 435 million people worldwide had access to fluoridated water, including about 57 million accessing water that was naturally fluoridated.

The most common risk of fluoridation is fluorosis, which occurs during childhood and is typically characterized by small white spots on parts of the teeth. It’s a cosmetic rather than structural concern, and quite a common one: 41 to 61% of American adolescents have fluorosis. Other risks, such as fluoride toxicity, are rare in the developed world, and often the result of children swallowing fluoridated toothpaste.

The benefits, however, are significant. A 2021 University of Calgary study found children in Calgary, after fluoride was removed, were significantly more likely to have dental caries than children in Edmonton (which has fluoridated its water since 1967). The results held even after controlling for socio-demographic factors, diet, dental hygiene habits and other exposure to fluoridation.

A pro-fluoridation group, Fluoride Yes!, has registered as a third-party advertiser during the election period.

Taylor Lambert is The Sprawl’s Alberta politics reporter.

*Original article online at https://www.sprawlalberta.com/referendum-questions-alberta-municipal-elections