Fluoride divide? Calgary second-graders more likely to have dental cavities than Edmonton counterparts

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A study by University of Calgary researchers has found poorer dental health amongst Calgary children compared to children in Edmonton, where the water supply is fluoridated.

Dental examinations of roughly 2,600 second grade students, with an average age of seven years old, in each of Alberta's two largest cities were collected over several months in 2018 and 2019.

The study found 64.8 per cent of the Calgary children in the study had at least one cavity, compared to 55.1 per cent of the Edmonton children.

The Calgary participants were born after the City of Calgary removed fluoride from its drinking water supply in 2011.

"Our findings are quite clear," explained Dr. Lindsay McLaren, a professor at the U of C's Cumming School of Medicine and the primary investigator in the study. "Fluoridation cessation is having a negative effect on children's dental health in Calgary.

"This reinforces the need for universal, publicly funded prevention activities — including, but not limited to, fluoridation of drinking water."

Researchers controlled for variables on dental hygiene habits, diet, socio-demographics and ethno-cultural backgrounds from questionnaires completed by parents.

According to McLaren, poor pediatric dental health can prove problematic in multiple facets of a child's development.

"Cavities can significantly affect children's health and well-being, and since Calgary stopped fluoridation, we have virtually nothing in the way of primary prevention for this almost entirely preventable problem," said McLaren. "Cavities can be painful, and they can affect a child’s ability to concentrate and learn. They can also be serious: for children under age six in Canada, cavities are the number one reason for day surgery performed under a under general anesthetic."

The results of the study have been published in Community Dentistry and Oral Epidemiology.

Opponents argue its health effects aren't completely understood.

Dr. Ben Greff, who is with the Fluoride Action Network in Calgary, believes in a more holistic approach to providing oral care without the use of fluoride.

“It’ s not really needed for any process or any reaction for our metabolism in our bodies and we know that there are systemic risks to our whole body by ingesting fluoride so that's why we avoid it,” he said.

Greff adds that there are a number of alternatives to using fluoride that will still help in strengthening enamel such as hydroxyapatite and theobromine, which he says are much safer to use.

Although, other dentists like Dr. Farida Saher who works at Dental Care For Children strongly disagrees with that claim.

She says dental decay is starting much earlier in her children clients because fluoride is no longer in Calgary’s water supply.

“The thing about fluoride is that when it's ingested in fluoridated water, the teeth are exposed for the moment that they're in that the waters in their mouth. That fluoride is then released in the saliva later meaning the teeth are always based in fluoride and also the teeth that are developing are stronger because they're exposed for a while,” Saher said.

“Unfortunately, in Calgary, not every child has access to a dentist, much less a pediatric dentist, so the great thing about fluoridated water, is it accesses everybody.”

Saher adds that tooth decay can require surgery, which is usually under general anaesthetic and could have been prevented with fluoridated water.

She says it could also lead to other problems such as periodontal disease which is associated with cardiac issues

The ongoing debate over fluoride in Calgary's drinking water will be included as a plebiscite question in the upcoming municipal election.

This will be the sixth fluoridation plebiscite in Calgary's history. Calgarians voted against fluoridation in 1957, 1961 and 1971. A slim majority of voters cast ballots in favour of fluoridation in 1989 (53 per cent) and 1999 (55 per cent)

The mineral was removed from the drinking water supply in 2011 when the fluoride bylaw was repealed.

According to city officials, the initial cost of reintroducing fluoride would be approximately $10.1 million and there would be annual operating costs of roughly $1 million. With consideration for the initial cost, operating costs, and maintenance, the city estimates the total cost would be roughly $30.1 million over the first 20 years.

Fluoride is a naturally occurring mineral that is present in nearly all water sources and is associated with reduced tooth decay. The Public Health Agency of Canada (PHAC) says fluoride molecules can strengthen teeth by hardening tooth enamel, contributing to tooth surface re-mineralization, and deterring oral bacteria.

For decades, governments around the world have added fluoride to public drinking water to reduce rates of tooth decay in children and adults.