The U.S. Center for Disease Control calls it one of the 10 great public health achievements of the 20th century, but in recent months two Canadian municipalities made national news for taking a second look at public water fluoridation. Concerned about its safety and effectiveness, Calgary decided last month to remove fluoride from its water supply and the Cape Breton Regional Municipality is considering doing the same.
Fluoride is added to municipal water to control tooth decay.
“I’m convinced that the amount that’s in Peterborough’s water is a perfectly safe dose,” Peterborough’s Medical Officer of Health, Dr. Rosana Pellizzari, told Arthur. The Peterborough County-City Health Unit supports fluoridation and as head of that agency, Pellizzari said the practice is a “safe,” “effective” and “ethical” way to promote oral health.
Peterborough fluoridates its water at a level of 0.5 to 0.8 milligrams per litre (mg/L), which is below the maximum allowed by Health Canada (1.5 mg/L). Pellizzari said Peterborough’s rate takes into account intake from other sources (fluoride is added to certain foods and is also found in many toothpastes). It is “low enough… that we’re not seeing an increased rate of fluorosis,” Pellizzari stated. Fluorosis is fluoride’s most widely agreed upon negative effect. Often dismissed as a minor cosmetic concern, severe cases can mottle and discolour teeth.
One of the key reasons why Pellizzari supports fluoridation is because of its ability to reach the entire population.
“It’s the most equitable way to reach children and people living in poverty,” she said. She pointed out that one sixth of the population lacks dental coverage, and therefore, does not receive dentist-administered topical fluoride treatments. Some form of fluoride treatment is widely considered key to good oral hygiene.
She also called it the most cost effective way to administer fluoride. Some cities that have opted out of fluoridation invest instead in topical fluoride treatment programs. Pellizzari said such programs usually only benefit children, leaving out other groups like seniors.
Opponents charge that fluoridation is unethical because it is given to people without their consent. Pellizzari dismisses this concern, arguing that such health interventions are common and beneficial. She compared fluoridation to fortifying foods with vitamins and minerals, iodizing salt, chlorinating water, limiting sodium in prepared foods, and efforts to ban trans fats, arguing that each is an important effort to improve public health.
For Pellizzari, the benefits of fluoridation are evident. She stated that there is a lower rate of tooth decay in the City of Peterborough than in non-fluoridated regions of Peterborough County.
Opponents, like University of Calgary biophysicist and co-author of The Case Against Fluoride (2010), James S. Beck, question these alleged benefits.
In his book, Beck argues that in the last 50 years, declines in tooth decay have been observed both in countries that fluoridate their water and in those that do not. Beck and other opponents contend that declines in tooth decay are linked to other factors like topical fluoride treatments and dietary improvements.
Health Canada and the U.S. Centers for Disease Control say that the serious health problems that research has suggested may be associated with fluoride—such as increased chance of hip fractures, impairment of thyroid function, adverse changes in the cardiovascular system, adverse effects on the development of the reproductive system and on the development of the brain and kidneys, and lower IQ among children—are not a concern at the low amounts added to municipal water supplies.
Beck argues that while the quantity of fluoride in the water may be low, its concentration and effect on individual human bodies varies. He makes the simple observation that different people drink different amounts of water—for instance a construction worker likely drinks more than an office worker—meaning that there are different concentrations of the drug in people’s bodies (he is adamant that fluoride is a drug). For Beck, this means that while the amount of fluoride added to the water is controlled, its dosage is not. He thus concludes that serious health effects dismissed by government authorities may be more real than they would like to let on.
Beck also calls fluoridation a breach of medical ethics. “It is clearly unethical to administer a drug… without control of dose, without monitoring by a qualified professional of the effects on the individual taking the drug or without informed consent.”
Pellizzari is not swayed. She called efforts to remove fluoride from municipal water by those like Beck “fear mongering.”
“I think there’s a very active and well-organized anti-fluoride lobby that’s been active for many years and I think they’re targeting municipalities right now,” she stated. While the federal government regulates limits of fluoride exposure, municipalities decide to fluoridate their water supplies or not.
At the same time, Pellizzari assures that the issue is “something we maintain vigilance on.” The Peterborough County-City Health Unit takes its direction on fluoridation from Health Canada. The agency is currently doing a review of research on the health effects and effectiveness of fluoridation, which, Pellizzari said, should be published soon.
“We’ll see if there’s any new evidence,” she said.
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