Calgary Community Water Fluoridation

The scientific literature on CWF is quite extensive with many systematic reviews, meta-analysis and many other single studies. To make any health recommendation, it is really important to appraise the quality of the studies and evaluate the applicability of their findings to the general population. After appraising all researches, the best scientific evidence available concludes that CWF is safe and effective in preventing tooth decay.

The study mentioned in your question is one single study showing an association with fluoride and unwanted health effects. With the scientific appraisal of this study and identification of its methodological limitations it was concluded that more research in this specific area is necessary. The findings of the study were not applicable to the general population or to the recommended level of fluoride as 0.7ppm

Community water fluoridation is safe and effective in preventing tooth decay. It is also safe to drink fluoridated water during pregnancy.

The best scientific evidence available in Canada and around the world supports community water fluoridation as safe and effective in preventing tooth decay. Other than mild or very mild dental fluorosis, the recommended water fluoridation level (0.7mg/l) does not have other unwanted health outcomes.

The evidence on fluoride and any unwanted health outcome is weak, it comes from single studies, and it is not applicable to the general population or for fluoride at the concentration recommended for community water fluoridation. The best scientific evidence available supports and recommend community water fluoridation for preventing tooth decay. Two studies from Mexico where salt fluoridation is used as opposed to community water fluoridation (CWF), found an association between mothers’ maternal urine fluoride concentration with IQ scores and attention deficit hyperactivity disorder in their children. The study conducted in Canada, about maternal urine fluoride concentration levels had several methodological limitations and the findings were not applicable to the general population.. After carefully reviewing this new research,  Health Canada concluded that the studies provide weak evidence, and the findings are  not generalizable and they cannot infer causality. A subsequent rapid review of this new evidence by the Canadian Agency for Drugs and Technologies in Health supports this conclusion. The overall weight of evidence on the relationship between CWF and cognition continues to support the safety of CWF; Alberta Health will continue to monitor new evidence in this area.

To assist with the understanding of health decisions based on scientific evidence, it’s important to understand the difference between findings of a single research/study and the findings from an assembly of studies. Findings from a single study are not always applicable to every population or community. If single studies have been rigorously conducted (using good scientific research methods), they may become part of the overall pool of a larger systematic review. Systematic reviews of the available scientific evidence provide a broader understanding and application to the general population. They provide policy makers more information and confidence for public health recommendations.  

This is the case with community water fluoridation: the current extensive body of scientific evidence supports and recommends CWF as a safe, effective and economical measure to prevent tooth decay. 

Eating a healthy diet, as well as brushing regularly with fluoride toothpaste, visiting your dentist regularly, and drinking fluoridated water, all contribute to good oral health. Community water fluoridation is one factor in a multi-pronged approach to prevent tooth decay.

Fluoridated water is effective because it keeps a low level of fluoride in the mouth, protecting teeth against acid attacks and can help reverse early stages of tooth decay. Ingested fluoride is incorporated into the structure of developing teeth during childhood, making the tooth enamel more resistant to decay after the teeth erupt.

Data from the last 10 years shows an average of 37,000 dental visits to Alberta emergency departments (ED) per year for dental problems. This includes more than 12,000 visits to Calgary-area EDs in 2019 alone. With the cost of an ED visit between $150 and $225, the annual cost is upwards of $2 million for Calgary Zone.

Community water fluoridation effectively helps prevent tooth decay, especially among the most vulnerable. Every $1 spent on community water fluoridation can save up to $93 per person in dental treatment costs. 

Fluoridated tap water is accessible to everyone connected to the municipal water supply, regardless of age, socioeconomic status, education, income, race or ethnicity.

Fluoride helps to keep your teeth healthy at any age. From the time you are a baby to your senior years, fluoride strengthens teeth and repairs damage caused by tooth decay acids. Getting an early start using fluoride has life-long benefits. Adults have less decay if they start using fluoride when they’re children.

Thank you for your question. Voting information is available through the City of Calgary. You can find information about where and when to vote as well as what will be on your ballot here: https://www.calgary.ca/election.html(External link).

Advanced voting is on October 4-10 and the final day to vote is October 18. Where to vote is determined by where you live, you can find information about that here: https://www.calgary.ca/election/information-for-voters/when-and-where-to-vote.html#where(External link). 

Please visit “What does the science say” at AHS Oral Health  to find systematic reviews and studies of community water fluoridation that support it as a safe, economical practice to prevent tooth decay.

Dr. Rafael Figueiredo, Provincial Dental Public Health Officer, Alberta Health Services

Young children may ingest fluoride from toothpaste before they learn how to spit. Reference tables for the amount of fluoride ingested from fluoride toothpaste in children over the age of 6 months are used in the calculation of total daily fluoride intake to stay within total daily safe limits by age group. In recognizing that children do receive fluoride in this manner, Health Canada requires manufacturers provide instructions for the proper use of fluoride toothpaste for children.  AHS provides a factsheet - Fluoride Toothpaste Tips for Kids for additional information about the supervision and use of age appropriate amounts of fluoride toothpaste. 

For accidental ingestion of large quantities of fluoride toothpaste, call PADIS – Poison and Drug Information Service – toll free at 1-800-332-1414

Please visit “What does the science say” at AHS Oral Health  to find systematic reviews and studies of community water fluoridation that support it as a safe, economical practice to prevent tooth decay.

Dr. Rafael Figueiredo, Provincial Dental Public Health Officer, Alberta Health Services

Ingesting fluoride from swallowing fluoride during an in-office topical fluoride application will not affect the teeth. High quality care minimizes swallowing and ingestion of fluoride.

All ages benefit from brushing their teeth or having them brushed with an age-appropriate amount of fluoride toothpaste to prevent tooth decay. Young children can be at risk of developing dental fluorosis if they consistently swallow more toothpaste than recommended. This risk decreases with age so that by age 8 swallowing fluoride toothpaste will not contribute to dental fluorosis. 

Please visit “What does the science say” at AHS Oral Health  to find systematic reviews and studies of community water fluoridation that support it as a safe, economical practice to prevent tooth decay.

Dr. Rafael Figueiredo, Provincial Dental Public Health Officer, Alberta Health Services

Please visit “What does the science say” at AHS Oral Health  to find systematic reviews and studies of community water fluoridation that support it as a safe, economical practice to prevent tooth decay.

Dr. Rafael Figueiredo, Provincial Dental Public Health Officer, Alberta Health Services

Yes, there are other methods of providing fluoride, but community water fluoridation is the best method of providing safe, low cost, economical prevention of tooth decay for everyone - no matter their age or ability to seek out other forms of preventive dental care. Currently across the province AHS provides specific, targeted programs to prevent tooth decay. While these and other preventive programs are effective they are limited to specific groups as they are too costly to provide to the entire population. Even with the utilization of other methods of providing fluoride, community water fluoridation still prevents a 25% or better reduction in tooth decay in adults and children alike.

Dr. Rafael Figueiredo, Provincial Dental Public Health Officer, Alberta Health Services