A recent University of Calgary/Alberta Health Services study comparing tooth decay in Calgary and Edmonton has again raised the issue of water fluoridation. The study compared tooth decay rates between grade two students in Calgary, which discontinued water fluoridation in 2011, and Edmonton, which still adds fluoride. I have read the study and appreciate that it continues the conversation on dental health.
Scientific research is constantly evolving and I trust the scientific community will review this study further, as well as contrast it with the many other studies on water fluoridation. In science, it is important that we do not rush to judgment on the results of one study, and instead, continue rigorous and on-going scientific review of the subject. Particularly with a health care measure that is applied to everyone, without the possibility of opting out, the burden of evidence is simply higher. I look forward to review of this study and to further review of public water fluoridation in general.
Although water fluoridation is a polarizing issue, the need for quality dental health care is not. The conversation on fluoride is often emotionally-charged and people on either side have stopped listening to each other. This damages and marginalizes the debate. Where we can agree is that good dental health for people of all ages, and particularly for children, is essential in maintaining whole body health. More and more studies suggest that healthy mouths lead to improved overall health. I continue to be supportive of efforts to improve dental health.
One of the conclusions from the study, and the most troubling, is that tooth decay rates are going up in both Calgary and Edmonton, regardless of fluoridation. While the rate of increase was higher in Calgary than in Edmonton, overall decay rates were slightly lower in Calgary than in Edmonton, both before and after Calgary ceased water fluoridation. This raises several important questions:
- Why, despite decades of water fluoridation, do decay rates continue to climb in Calgary and Edmonton? How is Alberta Health Services addressing other and more systemic causes of tooth decay?
- Why are the overall decay rates slightly lower in Calgary, than in Edmonton? Does this point to other factors?
- There are other options to water fluoridation. Many other jurisdictions have programmes that provide measured and topical doses of fluoride to children in schools. Given that dentists typically recommend fluoride as measured doses such as topical rinses or gels, has Alberta Health Services explored such options?
- Alberta is the only province in Canada without a dental fee guide and has far higher dental fees than other provinces. In Alberta, dental fees continue to increase at twice the rate of inflation, pricing many Alberta families who do not enjoy employer provided dental benefits out of accessing dental care. Will the Provincial Government ensure dental equity through affordable dental care rates?
- It is estimated that 80% of tooth decay is found in 25% of the children, particularly from low-income populations who are impacted by unhealthy diet and lifestyles and unaffordable dental fees. Are all three orders of government doing enough to combat systemic issues of poverty and is the Provincial Government doing enough to improve access to early childhood care?
- The Alex Dental Health Bus was purchased by The City of Calgary to provide oral health services to thousands of children who would otherwise be un-served. There are still 192 clients on the waiting list. Would Alberta Health Services consider providing financial support to expand this excellent, necessary, and over-subscribed program?
Access to free, safe, and clean drinking water is a basic human right. Many Calgarians are though concerned about adverse health effects of ingesting fluoride. The World Health Organization acknowledges that, “fluoride has both beneficial and detrimental effects on human health.”
Fluoridating the public water supply leaves no option for those who want to opt out, particularly those living in poverty. In Western Europe, 97 percent of the population drinks non-fluoridated water (more people drink fluoridated water in the US alone than in the rest of the world combined). Many European countries decided to stop adding fluoride to their public water supply in the 1970s and 80s, citing adverse health effects, the importance of choice, and instead offer free and easy-to-use options like fluoridated table salt or oral rinses. With alternatives available, I respect the value of individual informed consent – a founding principle of personal health.
Dental care, like all health care, is the responsibility of the Provincial Government. With decay rates increasing in Alberta cities, regardless of whether or not they add fluoride to public water supplies, it is clear that there is no single solution for dental health. I encourage the Provincial Government to consider the many easy alternatives to water fluoridation, as well as systemic solutions to improve the dental health of all Albertans.
A few questions about the study that should be explored as topics for further research:
- The study compares decay rates over a nine-year period (2004/2005 versus 2013/2014), but attributes and assumes that the increase in Calgary decay rates only happened in the last two and one half years of the study period. The magnitude of change on any study depends on both the start and end data. Calgary ceased water fluoridation in 2011, not 2004. Were decay rates going up before 2011?
- Another study was conducted in 2009/2010 that shows that decay rates were increasing in Calgary, prior to the cessation of fluoridation. Is the 2009/10 study a more relevant comparison point than the 2004/2005 data?
- The 2004/2005 sample size in Calgary (599 children) was much smaller, was income-stratified, and had a 60% response rate. The 2004/2005 Edmonton test group (6445 children), was not stratified by income, and had an 89% response rate. Is the original study, on which the rate of change is based, statistically valid?
This content represents the personal views and opinions of the Ward Councillor and should not be taken as a statement of policy of The City of Calgary. The inclusion of any external content does not imply endorsement by The City of Calgary.