As oral healthcare professionals and public health experts, we write to decry the fact that the water treatment plants at Pockwock Lake and Lake Major ceased adding fluoride, and did so without notifying the public.
Community water fluoridation is an important public health measure that helps everyone by reducing dental decay by approximately 25%. The U.S. Centre for Disease Control (CDC) considers water fluoridation as one of the ten great public health achievements of the 20th century. While water fluoridation benefits everyone, it is most helpful to those without other preventive measures because of their lack of knowledge of, or inability to afford, fluoridated toothpaste, a diet low in simple sugars, or visits to an oral health provider. Whereas these latter preventive measures require knowledge, deployment and funds, water fluoridation reaches everyone, without people needing to do anything but drink the water.
The evidence overwhelmingly supports the practice of water fluoridation as effective and safe. Its effectiveness is obvious in studies that report what happens when fluoridation ceases: decay rates rise dramatically. Moreover, fluoridation is also highly cost-effective. According to a 2016 study, for every dollar invested, approximately $16.5 dollars are saved in avoided dental expenses.
Some people claim that fluoridation is harmful. It is not. Fluoridation has more than 75 years of evidence of safety. The only “harm” that reliable evidence associates with fluoridation is mild dental fluorosis. This is a mere cosmetic condition consisting of white flecks visible only under bright light. They do not affect the structural integrity of the teeth or cause any physical impairment.
Some researchers repeatedly claimed that fluoridation harms children’s intelligence. But is highly unlikely to be true. Their studies are flawed, riddled with methodological mistakes, particularly poor measures of fluoride intake and of preschool children’s IQ. Larger and longer-term studies with better measures in Sweden, Australia and New Zealand show no effect. There is no reliable evidence that water fluoridation has ANY effect on IQ levels.
Even though the benefits of water fluoridation are obvious and the risks negligible, and the people of the Halifax Region want fluoridation, the fluoride units at Pockwock Lake and Lake Major were offline from May 2023 and April 2020, respectively, because of equipment and repair issues. If the water operators had notified the public, then we could have advised patients to seek other fluoride preventive measures such as fluoride rinses and high fluoride containing toothpastes, and to be extra vigilant in brushing and flossing. We also could have adjusted the frequency of dental check ups and fluoride applications until fluoridation was returned. And perhaps more importantly, we could have told water operators that the reintroduction of fluoridation is an urgent public health matter.
In Nova Scotia, dental cavities in young children are a big problem, causing pain and infection. Hundreds of children present to the IWK emergency room each year with dental related emergencies. Nova Scotian children face significant wait times for dental services, more so for complex cases requiring sedation. Treatment of dental disease demands approximately 30% of the day surgical time at the IWK. Exposure to fluoride from all sources lessens the burden of disease for children and the stress on the health care system. The province cannot afford to abandon a well-proven protective measure against tooth decay in children.
The Halifax Water communication regarding fluoridation cessation was disappointing. It came four years late regarding Lake Major and one year late regarding Pockwock Lake. Not only did the official statement contain no apology, it failed to state who in management would take responsibility, why the utility was not acting swiftly, and what steps were being taken to ensure cessation does not occurred again. Concentrated chemicals like chlorine and fluoride are challenging to work with. But such work is the water operators’ responsibility. The argument that three to five years is needed to reinstate water fluoridation at Lake Major would never be tolerated were an oil company to have an operational problem that jeopardized public health.
To be sure, Pockwock Lake has now resumed fluoridation, but the harm for children who grew up without cannot be undone.
The people of Dartmouth deserve water fluoridation now. They have been deprived too long. We urge the Halifax Regional Council to investigate and to require that fluoridation at the Lake Major plant be returned urgently. If the issue is financial, then the Halifax Regional Municipality must advance the funds because of the great savings the investment provides.
Everyone benefits from fluoridation, especially children, seniors and disabled people. They rely on elected officials to cause Halifax Water to work for us, the people who pay for the utility.
Violet D’Souza, Shauna Hachey, and Abdulrahman Ghoneim are faculty members of Dalhousie University’s Dental School. Tracy Doyle and Jennifer MacLellan are pediatric dentists at IWK Health