April 4, 2011
As Chief Medical Officer of Health for Ontario, I am very concerned about the loss of fluoridated drinking water in certain communities in spite of consistent evidence that water fluoridation is safe and effective.
More than 90 national and international professional health organizations, including Health Canada, the Canadian Public Health Association, the Public Health Agency of Canada, the Canadian Dental Association, the Canadian Medical Association, the U.S. Centers for Disease Control and Prevention (CDC) and the World Health Organization, have endorsed the use of fluoride at recommended levels to prevent tooth decay.
In fact, the use of fluoride in drinking water has been called one of the greatest public health achievements of the 20th century by the CDC.
Combats Tooth Decay
The benefits of water fluoridation are well documented. According to expert research, fluoridated drinking water reduces the number of cavities in children's teeth, which contributes to their healthy development. Reductions of tooth decay have also been observed in adults and seniors who reside in communities with fluoridated water. Even with other sources of fluoride available today, the American Dental Association estimates that water fluoridation continues to be effective in reducing tooth decay by 20-40 per cent.
Conversely, removing fluoride from drinking water systems has the potential to contribute to increased rates of tooth decay. The findings of several studies, including from the CDC, suggest that tooth decay generally increases in a population after water fluoridation is discontinued. In addition, a 2007 report on water fluoridation by the Institut National de Santé Publique du Quebec reveals that the percentage of kindergarten children at high risk of developing tooth decay in Dorval, Quebec doubled in the two year period after water fluoridation was halted in 2003.
Reduces Dental Care Expenditures and Inequalities in Health
Water fluoridation also has the capacity to help reduce dental care expenditures. The Ontario Dental Association has stated that the cost of waiting until tooth decay has manifested is significantly higher than the cost of preventing it in the first place. The CDC estimates $38 in avoided costs for dental treatment for every $1 invested in community water fluoridation. With the fluoridation of drinking water playing an important role in the overall promotion of good oral health and prevention of dental decay, I am concerned that removing it from drinking water may put a strain on, and impact the success of, important provincial programs such as the Children in Need of Treatment Program and Healthy Smiles Ontario - both developed to benefit those least able to afford dental services.
And indeed, removing fluoride from drinking water will place those least able to afford or access dental treatment at an increased risk for oral health problems. The health benefits of drinking water fluoridation extend to all residents in a community, regardless of age, socioeconomic status, education or employment.
Fluoride in drinking water is also safe. In Ontario, fluoride additives are required to meet rigorous standards of quality and purity before they can be used. When they are added to water at levels recommended in Ontario and across the country, studies have not linked fluoride to cancer, bone fractures or intelligence levels. Studies have also found that water fluoridation is safe for the environment, and poses no risk to plants and animals.
In addition, most dental fluorosis, a condition that occurs when a child receives too much fluoride during tooth development, is mild and appears as white stains on the teeth. In this mildest form, fluorosis may affect the look of a tooth, but will not affect its function. While moderate or severe fluorosis does occur, the Canadian Health Measures Survey: Oral Health Statistics 2007-2009 concludes that, "[so] few Canadian children have moderate or severe fluorosis that, even combined, the prevalence is too low to permit reporting. This finding provides validation that dental fluorosis remains an issue of low concern in this country."
The importance of maintaining good oral health should not be taken lightly - it is an important part of being healthy overall. As tooth decay is the single most common chronic disease among Canadians of all ages and poor oral health is linked to diabetes, heart disease and respiratory conditions, water fluoridation is, and must be recognized as, a very important public health measure.
An estimated 70 per cent of Ontarians currently have access to water that is fluoridated, and I would urge all Ontarians to continue to support the fluoridation of their municipal drinking water systems so that everyone can enjoy the lasting health benefits.
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