Debate swirls around fluoridated water

Weigh potential health risks against tangible benefits, says Swetha Rajah.

A healthy smile should not depend on socioeconomic status. For decades, fluoride has been hailed as a champion in the fight against tooth decay among people from all social backgrounds. Its introduction into municipal water supplies in the 1940s marked a watershed moment in preventive dentistry. Yet since 2017, several Canadian municipalities have discontinued adding fluoride to drinking water and as recently as 2022, only 38.8 per cent of Canadians had access to fluoridated water.

The cessation of community water fluoridation has left a hole in the oral health landscape, particularly among vulnerable populations. According to the Inuit Oral Health Survey conducted in 2008-09, more Inuit in Canada reported poor oral health and higher frequency of oral pain when compared with the non-indigenous population in Canada. Children from lower-income households bear the brunt of this decision, with dental problems being a major reason for visits to emergency rooms.

From its origins in naturally occurring water sources to its artificial supplementation, fluoride has consistently demonstrated its prowess in safeguarding dental health. The U.S. Centers for Disease Control and Prevention (CDC) considers community water fluoridation one of the 10 greatest public health achievements of the 20th century. The plummeting rates of tooth decay in fluoridated areas speak volumes about its effectiveness.

It's high time to acknowledge that the effects of what we consume extends beyond the dinner or dessert plate to what we drink, including the water from our taps.

So what was the rationale for some jurisdictions to ban the fluoridation of drinking water?

Studies from Mexico and Canada in 2019 suggested a potential link between systemic fluoride intake and neurotoxicity, especially during fetal developmental stages. While the evidence remains inconclusive, it has provided ammunition for fluoridation's critics.

In 1984, the World Health Organization found insufficient evidence to link fluoride to cancer or birth defects. But it recommended a guideline value of 1.5 mg/l to minimize dental fluorosis (a condition characterized by the presence of white spots or discoloration on the teeth). This guideline value was re-evaluated in 1996 and 2004, with no evidence suggesting a need for revision.

Concerns over potential health risks, however tenuous, seem to have prompted some regions to err on the side of caution. Ontario, Alberta and Manitoba have the highest percentage of community fluoridation in Canada with rates of between 70 per cent and 76 per cent. At one per cent, Quebec is among the lowest rates of water fluoridation in Canada.

Yet, amid the debate, a fundamental question arises: Is it ethical to neglect the oral needs of the marginalized?

While the affluent may have access to dental care, the same cannot be said for those struggling to make ends meet. Although there has been an increase in funding for dental care in 2023, aimed at extending coverage and establishing an Oral Health Access Fund, prioritizing preventive measures such as community water fluoridation arguably holds greater promise than solely focusing on treatment interventions.

Mass medicating the municipal water supply might not sit well with some, but for the unemployed and underprivileged, it could mean the difference between a healthy smile and a lifetime of dental woes.

Moreover, the economic implications of fluoride cessation cannot be ignored. With dental expenditure skyrocketing and the burden falling heavily on insurance companies and families, the return on investment from fluoridation becomes increasingly apparent. Even smaller towns stand to benefit, with every dollar invested in fluoridation yielding a 20-fold return, according to the CDC.

In navigating the fluoride debate, a delicate balance must be struck between public health imperatives and health risks. Potential risks deserve attention, but must be weighed against the tangible benefits fluoride brings, particularly to those on the margins of society. After all, a healthy smile knows no socioeconomic boundaries.