March 2009 - Hot Topic

Community Water Fluoridation in Ontario

by Dick Ito, President, Ontario Association of Public Health Dentists

A small but well organized group of committed anti-fluoridationists has been urging municipal and regional councils to discontinue community water fluoridation claiming that fluoride in the drinking water is harmful. In 2008 alone at least 6 municipalities in Ontario (Dryden, Halton, Hamilton, Norfolk, Niagara Falls, and Waterloo) were challenged to discontinue community water fluoridation. Two of these challenges have led to decisions by city or regional councils to not restart community water fluoridation. Concurrently, the Government of Canada and the Ontario Ministry of the Environment have also received several petitions from individuals to cease community water fluoridation.

Optimizing fluoride levels in the drinking water started in Brantford, Ontario in 1945 as the initial test city. Comparison of caries prevalence (the number or proportion of persons in the population who exhibit dental caries or decay at any one time.) and severity (mean number of carious or decayed teeth per person in the population) in Brantford children to those from Sarnia, which was the non-fluoridated control site over an 11 year period, indicated a 63% reduction in caries severity and a 35% reduction in caries prevalence. Similar results from other countries led to many Ontario municipalities to begin fluoridation in the 1950s and 60s. Now, about 8.5 million people (70%) in Ontario receive fluoridated drinking water. Fluoride levels are carefully monitored regularly to ensure that the optimal level is maintained as is required under the Ontario Public Health Standards.

World-wide the British Fluoridation Society reported that in 2004 about 350 million people had access to optimally fluoridated drinking water including countries such as: the United States, Canada, Argentina, Ireland, Spain, Australia, New Zealand, Hong Kong, Singapore, Israel, and the UK, and an additional 50 million had naturally fluoridated drinking water at optimal concentrations.

The safety, efficacy and effectiveness of community water fluoridation have been extensively researched throughout the more than 60 years since it was introduced. Between 1997 and 2007 there were 18 major reviews on fluoridation, the most recent of which are the 2007 reviews by the Health Canada Expert Panel, the Institut national de santé publique du Quebec and the National Health and Medical Research Council of Australia. These reviews have found that:

  • fluoridation is safe;
  • no evidence has been found that it causes cancer, bone disease, kidney disease, birth defects or other adverse health effects;
  • there is no evidence that adding fluoride to the drinking water has negative environmental impact;
  • fluoridation is still effective even though other sources of fluoride such as toothpastes and topical fluorides, are used;
  • fluoridation benefits all residents served by community water supplies regardless of their social or economic status; and,
  • fluoridation is the most cost-effective means of delivering the benefits of fluoride to whole communities.

Through position statements, community water fluoridation is supported by:

  • the Royal College of Dental Surgeons of Ontario;
  • the Ontario Dental Association;
  • the Ontario Dental Hygienists Association;
  • the Ontario Agency for Health Protection and Promotion;
  • the Ontario Association of Public Health Dentistry;
  • the Government of Canada;
  • Health Canada; and
  • the Public Health Agency of Canada.
Many other dental, medical, health and other organizations around the world have endorsed community water fluoridation. Nonetheless, the small but vocal group persists in pursuing local authorities to stop community water fluoridation claiming health risks that are not supported in the scientific literature.

For more information see the Health Canada website.