CALGARY — One child’s teeth were in such poor condition she found it too painful to eat. The child, born after Calgary removed fluoride from the city’s drinking water in 2011, was starting to look thin and malnourished, recalls Denise Kokaram, program lead of the Alex Dental Health Bus.
“At that point, the problem was escalating. The estimate for care was beyond (the parents’) scope. They couldn’t afford to fix it and the child started to lose weight,” she said.
“She needed to go into an operating room and there were barriers with language. Now the parents had concerns about putting the child under general anesthetic because … the disease was so severe.”
These are the kinds of cases that Kokaram is seeing more and more frequently with the Alex, which has outfitted a mobile dental office in a bus. It travels to kids in high-risk schools offering dental checkups and referrals.
A recent study that compared the incidence of cavities in Calgary with Edmonton (which maintains water fluoridation) found that Calgary children’s teeth got relatively worse compared with those of their less wealthy, less educated counterparts in Edmonton. While the study said nothing positive about council’s decision to stop water fluoridation, neither was it perfectly damning.
Based on the study, some Calgary councillors are urging a re-examination of the decision to remove fluoride from the water.
When fluoridation is ceased, it’s poor kids who suffer disproportionately.
Rich kids get better food, their parents are better educated about dental hygiene, and they’re more likely to have access to dental benefits — including supplementary fluoride treatments and rapid access to care before minor cavities progress to abscesses or other serious issues.
Kokaram said data collected by the Alex showed a clear increase in the severity of dental disease among the children it serves.
“There are so many barriers to them being able to receive the proper dental care. That’s one of the reasons we do a lot of advocacy around water fluoridation; we know from the evidence that this is the broadest way to reach this population,” Kokaram said.
Many of these parents simply can’t afford serious dental surgery for their kids; many hope they can simply wait for infected baby teeth to fall out in favour of adult ones — a decision that leaves their kids in pain and, potentially, dealing with more serious surgeries for problems left untreated over time.
“It’s very heartbreaking,” said Kokaram, who used to work in Ethiopia, Rwanda and Kenya. “My team always takes pictures and when I look at those and review those — I’ve worked overseas and I don’t expect to see what I see there here.”
It was these kinds of reports that brought around counsellors such as Diane Colley-Urquhart, who supported de-fluoridation in 2011 and is now putting forward a notice of motion asking the issue to be studied by the O’Brien Institute for Public Health. She and two other councillors are seeking advice by December.
“I do recall, when I went into that vote, I was getting emails and articles from around the world telling us to get rid of it,” she said. “That’s one of the problems with politicians making public health policy. Even myself, (with a health background), I know a little bit about fluoride but not a hell of a lot.”
While campaigning for re-election — and well outside the polarized intellectual bubble that had surrounded council — she said she took a lot of heat at the doors of her constituents.
In Calgary, much of the debate about fluoridation rested on a petite libertarian argument around personal choice — that people should have the right to decide for themselves whether they wanted to be exposed to the ion. Five years later, that tidbit of sophistry has failed to hold up. Fluoride is, quite simply, not harmful when used in the marginal doses that First World nations adopt for their drinking water. Fluoride has been one of the most positive public health interventions in human history — especially for poor kids who don’t have the luxury of playing municipal politics or engaging in Socratic dialogues on personal choice.