When Golden goes to the polls on November 19, citizens will have the opportunity to vote in a referendum to decide whether or not the town should re-institute a fluoridation program for the municipal water system.

And, while it comes down to a simple ‘Yes’ or ‘No’ vote, the issue of fluoridating municipal water systems has in recent years created quite a furor between members of the dental community – who believe it to be a sensible and perfectly healthy practice – and those who argue that fluoride poses an invisible threat to public health.

â THE BACKGROUND

Fluoridation of Golden’s water system began following a referendum in the 1970s. At the time, it was in keeping with common practice.

In the early 1900s, a scientist first observed brown stains on the teeth of residents of Colorado Springs, a condition known as ‘mottled teeth’. While not aesthetically pleasing, these teeth proved to be resistant to decay and therefore stronger at fighting cavities.

Researchers years later determined that it was the presence of naturally-occuring fluoride in water caused mottled teeth, the condition from then on referred to as “dental fluorisis”.

But mottling would not take place, scientists found, if fluoride levels dropped below 1 ppm.

It wasn’t long before the concept was floated of adding fluoride to municipal water systems to adjust the concentration of natural levels and to prevent cavities.

Proper public education on dental hygiene wasn’t as prevalent as it is today, and it seemed logical for governments to help those who couldn’t help themselves in this regard.

In 1944, Grand Rapids became the first city to begin flouridating their water system. Fifteen years later, it was noted that cavities were reduced by 60 per cent in area school children. Other centres soon began to follow suit, including Golden.

â THE ISSUE

Golden discontinued its fluoridation program over a year ago, citing safety concerns about the current state of its equipment and infrastructure.

“Basically, our water wells aren’t up to Workers Compensation Board standards,” says Chris Radford, manager of operations for the Town, who points out that regulations on fluoridation require a separate room for ventilation. (Pure fluorine gas can be potentially lethal)

Other centres within the Interior Health Authority region, most notably Kamloops and Kelowna, have discontinued their programs through referenda within the last 10 years. Cranbrook, Sparwood and Williams Lake, however, continue to fluoridate their municipal systems.

Radford has estimated that in order to bring all of Golden’s five wells up to code, it will cost nearly $139,000. “It would be a substantial capital cost, for sure,” he says. “So now it’s going to be taken to the taxpayers to decide if it’s justified to put the money into the wells.”

Which brings us to the grand debate: to fluoridate or not to fluoridate.

â THE PROPONENTS:

The Canadian Dental Association (CDA) supports the use of fluorides in dentistry, declaring it “one of the most successful preventative health measures in the history of health care.”

The official position of the CDA is that nearly 50 years of “extensive research throughout the world” has shown the safety and effectiveness of fluorides in the prevention of dental caries (or, tooth decay).

The CDA goes on to say that fluoridation of municipal water (at recommended levels) is a “safe, effective and economical means of preventing dental caries in all age groups.”

This position was adopted by the CDA board in February 2005.

Indeed, numerous studies worldwide in the past half century have indicated that fluoride enhances calcium binding to the enamel, resulting in enamel which is more resistant to erosive influences.

Interior Health Authority (IHA) also believes fluoridation to be important from a public health standpoint.

Dr. Nelson Ames, IHA’s medical health officer for the Kootenays, has in the past year met with the Town officials to discuss the matter – drawing on literature from Health Canada, the CDA and the Centers for Disease Control in Atlanta.

“The objective evidence would be that basic fluoridation increases dental health across the whole spectrum of the community’s population and that was my recommendation to council,” he says.

Ames believes strongly that fluoridation of municipal water constitutes “positive intervention” from a public health perspective (versus “protection intervention”, which would be neccessary in the case of an infectious disease.) “It’s a societal investment in terms of health for the whole community,” says Ames.

“It levels the playing field for those who either can’t afford to, or are unable to, practice dental hygiene due to lack of education or exposure or opportunity. It gives these people the same benefit as those who floss every day and use flouride mouth rinses.”

â THE OPPONENTS

Some groups, like the Coalition of U.S. Enivronmental Protection Agency Unions, have called for a moratorium on public water fluoridation, arguing, albeit based on a single, unrepeated study, that the fluorosilicates used in many public water systems are collected from phosphate fertilizer industry smokestack scrubbers.

This can contribute to increased lead concentrations in public water, opponents say. It has also been suggested that high levels of injected flouride in water can lead to bone disease, skeletal defects and even cancer.

“If you take a look at anti-fluoridist literature, it’s poor and it’s not reproducable,” says Kamloops-based dentist Rick Hallett, who is also a director for the CDA. “It’s scare tactics and it’s very hard to oppose scare tactics, because the general population does not trust science.”

Many others have argued that if people brush their teeth, floss and visit the dentist twice a year, there is no need to add fluoride to the municipal water system.

Axing the flouridation program could do much to alleviate health concerns about over-exposure to fluoride and, in Golden’s case, free up more money for other public works.

“The debate may centre around the concern that by adding fluoride to the water we are fluoridating everything,” says Golden dentist Dr. Jeff Dolinsky.

“On the other hand, there are numerous socio-economic situations where citizens do not practice adequate home care nor do they seek professional prevention. The fluoride in the water is the only thing helping reduce dental caries in their case.”

Dolinksy says that the Town has a budget for preventative dental health, and, regardless of whether or not fluoridation is voted down at the upcoming referendum, this budget must not disappear.

“An alternate program needs to be funded to prevent the disastrous effects of inadequate prevention…it is incumbent upon us to help prevent dental caries as [the problem] is still pervasive in our community.”