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August 18-31
VOL.14 ISSUE. 26

You Handled The Tooth

Paul Dechene
Published Thursday March 3, 06:43 pm
Headline writers love fluoride stories because: dental puns

You dodged a bullet, Saskatoon. A bullet aimed right for your teeth.

Remember back in 2011 when the city was doing upgrades to its water plant, including the equipment that adds fluoride to the system? And remember how a group formed that wanted to put an end to the fluoridation program? We reported on the whole controversy at the time [“Tooth Of The Matter”, June 2, 2011].

In the end, the anti-fluoridation movement didn’t go anywhere and Saskatoon kept the program.

But just next door in Alberta, in that same year, Calgary caved to the pressure and shut their fluoridation program down. And it looks like they’re paying the price.

Or, rather, their children are.

According to a University of Calgary report published in Community Dentistry and Oral Epidemiology journal and in the International Journal for Equity in Health, between 2005 and 2014, Calgary saw its cavity rates for kids in Grade 2 rise an average of 3.8 tooth surfaces. Meanwhile, in Edmonton, which still fluoridates its water, the cavity rate only rose by 2.1 — almost half the Calgary increase. And the researchers attribute much of that difference to Calgary’s lack of a fluoridation program.

Still, that’s one study. And as it’s been five years since I wrote that municipal water fluoridation story, I decided to double check to see if the science on fluoridation had changed at all.

It hasn’t. First off, almost every major health organization still recognizes that municipal water fluoridation is safe and effective, including the World Health Organization, the Canadian Dental Association, the Canadian Medical Association and the Canadian Paediatric Society.

I also checked in with Gerry Uswak, the dean of the University of Saskatchewan’s College of Dentistry and asked him if water fluoridation still works.

“Yes it does,” says Uswak. “Does it work to the same level as we saw when it was first implemented? No, because back in the day, [cavities] were endemic.

“Everybody had them. If you were [cavity] free, that was the weird thing,” he says.

“You’ve had a generation now of community water fluoridation, you’ve got fluoride in food products from community water fluoridation. So in areas where there’s no water fluoridation, they’re still getting fluoride via community fluoridation through [food] products. There’s sort of a pervasive positive effect,” Uswak says.

That pervasive impact of fluoridation is called “the halo effect” and refers to the fluoride you pick up from juice, pop, beer and food and beverages that are produced in fluoridated communities. But, as more and more cities discontinue their programs, that halo effect weakens.

All together, municipal water fluoridation along with the halo effect from fluoridated foodstuffs form a base layer of defence against dental disease. And while losing that may not be a huge problem for people with dental benefits who can therefore afford regular care, for underprivileged populations, research has shown the damage is pronounced.

“We’re seeing a lot of really rampant decay in new Canadians and refugees coming to Saskatoon,” says Uswak. “And First Nations or anyone who has a variety of access-to-care barriers. [Fluoridation is] significantly important for the under-serviced population because for about a dollar per person per year, as long as you drink the water, then at least you’re getting some protective benefit to mitigate your risk of disease.”

Why all the concern over cavities, though? They’re such small things. Are they really so dangerous they justify continuing with such a controversial program? Well, actually, you could say they are.

“Left unchecked, we now know that people die,” says Uswak. “There are people who have died in America and Canada because of secondary infection. So, a dental abscess, it spreads and they don’t get it treated, it becomes a larger infection and lots of times it lodges in the brain and has killed patients. Others have got significant morbidity from [dental disease] causing significant stay in hospital.

“Untreated disease, there’s millions and millions of hours lost from school and work in Canada due to something as simple as dental disease, [cavities] that are preventable. It’s not just teeth. The question is, what is the value of a virgin tooth? I think people need to realize that oral health is important in and of itself and it’s vitally important to systemic health.

“You run a marathon but you have rotten teeth? I don’t care that you can run the marathon. You’re not healthy.”

Okay. Dental disease is bad. But to hear the anti-fluoridators speak, the dangers of fluoride are much worse. Opponents to municipal water fluoridation have argued that the chemical is linked to increased cancer rates and to diseases like dental and skeletal fluorosis.

As with most things, though, the dose makes the poison. In Canada, cities only boost their water fluoride levels to 0.7 parts per million. And according to Uswak, even when you add that to all the other sources of fluoride people are exposed to, the dangers are negligible.

“If someone says to us, fluoride’s a poison. Yeah, so is chlorine. It’s the same thing but we accept chlorine because it purifies our water. Some people don’t accept fluoride because they think it sullies their water. There’s the political edge of things: ‘It’s mass medication without informed consent.’

“And you know what? I can see people’s point. I’m to the point where now whenever I talk about water fluoridation, I say, you know, it’s up to you. I can respect your rights and if you choose to use the democratic process and have referenda and vote to have it taken out, I’ll support that. But I’ll tell you, I think [fluoridation] works and here’s the downside: your dental costs going up over time without fluoride. That’s what’s happening in Calgary: increased decay.”

And while dental disease rate data in Saskatchewan hasn’t been as carefully compiled as was done for the University of Calgary study, it is pretty clear that here in Saskatoon, where we fluoridate the water, we have fewer cavities than those barbarians in the capital where the fluoridation fad has never caught on.

So even if you aren’t a fan of municipal water fluoridation, take heart. At least, on average, you have better teeth than they do in Regina.

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