October 27, 2021

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Sask. dental public health expert debunks myths about fluoridation

“It’s just like the chlorine in drinking water. In the right concentration it is protective because it purifies the water, but in a certain concentration chlorine gas has been used in wars because it’s deadly.”

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A character in the 1964 movie Dr. Strangelove believed communists were adding fluoride to American water and called it the “the most monstrously conceived and dangerous communist plot” they’ve ever had to face.

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The movie, which satirizes the Cold War, pokes fun at the thought of water fluoridation being used as a weapon of war.

“There always has been a huge political aspect to community water fluoridation,” said Gerry Uswak, an associate professor of dental public health at the University of Saskatchewan’s College of Dentistry, after making a reference to the well-known comedy.

Adding fluoride to water is once again fuelling debate locally, as Regina city council gets set in August to consider a community fluoridation program.

Uswak, who is also the referral consultant dentist for the Saskatchewan Health Authority, says that for anti-fluoridationists, their opposition is less about fluoride and more about personal choice.

“Nobody is out there protesting fluoride in toothpaste… Nobody is out there protesting that your dental hygienist provides you with a fluoride treatment after cleaning your teeth, but it becomes political … because it pits … individual choice against indemnifying the entire population against disease,” he said, during an interview Monday.

Despite a select group of people with very strong views against fluoridation, he said there is no reputable scientific evidence that suggests it has any negative health impacts when provided at recommended levels (in Canada, that’s 0.7 parts per million or ppm).

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In fact, he said the opposite is true.

Major studies done over the past 10 to 15 years in Canada, the United States, Australia and the United Kingdom show that community water fluoridation is an “excellent mechanism for helping prevent dental decay,” said Uswak.

So why are some so adamant that the practice is dangerous,  and unhealthy?

Uswak said one can compare it to how a notorious study that manipulated and misinterpreted data to show a connection between vaccines and autism bolstered an anti-vaccine movement. The study was later retracted.

Over the years, he said studies on community water fluoridation have claimed a variety of “deleterious” effects, but when organized dentistry analyzed the data, they found it to be flawed.

One in the 1970s that said communities with fluoridated water had higher rates of cancer failed to control for age, he said. When age and other factors were properly accounted for, he said they found no such evidence.

There were also studies claiming community water fluoridation led to a higher incidence of Down syndrome in babies born to women who grew up in fluoridated communities, but Uswak says the hospital used for the study saw patients mostly from non-fluoridated communities.

More recent studies in Mexico and Canada suggesting fluoride can have effects on the intellectual development of children used data from communities with fluoride levels “far in excess” of what a program in Regina would use.

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“It’s just like the chlorine in drinking water. In the right concentration it is protective because it purifies the water, but in a certain concentration chlorine gas has been used in wars because it’s deadly,” said Uswak.

While the practice is used around the world, he said some communities face financial barriers and others remain hesitant due to a lack of experience given that the practice originated in North America and then “radiated out from there.”

“It goes back to the turn of the century where it was discovered in Colorado at the time when dental decay was endemic in the population,” Uswak explained.

A dentist found a sub-group of people who weren’t suffering from dental decay, but had brown-stained teeth. A closer look found naturally-occurring fluoride in their water supply at a concentration of 12 ppm. From there, U.S. public health determined a concentration of one ppm “had the best balance between preventing decay and not having deleterious effects on the teeth like brown staining or fluorosis.”

In 2008 — based on recommendations from an expert panel — Health Canada reduced the previous range of 0.8 to 1.0 ppm to 0.7 ppm “to help prevent excessive intake of fluoride through multiple sources of exposure,” according to the Canadian Dental Association (CDA).

Other sources of fluoride include toothpaste, convenience foods and purchased food prepared with fluoridated water, said Uswak.

“Anyone in organized dentistry endorses community water fluoridation if they follow the evidence-based science,” he said. “At some point, people in the population have to decide — why do oral health people recommend community water fluoridation and why should they believe them versus believing lay people who cherry pick research to support their opinion.”

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