The Calgary Journal
The Calgary Journal

Low-income kids and seniors are paying the price for taking fluoride out of Calgary's drinking: say some dentists, agencies

014"Do you floss?"

On a cold winter day, dental assistants inside The Dental Health Bus asked a couple of kids how they take care of their teeth. Another 161 children are on the waitlist for care.

From the outside, the bus looks like any ordinary trailer, but inside are: two chairs, a sterilization area, an abbreviated reception desk with a printer and an x-ray machine. The Dental Health Bus is run by The Alex, a Calgary social service agency. It travels to lower income areas checking kids' teeth and providing sealants to help prevent tooth decay.

The need is urgent because three years after Calgary city council removed fluoride from Calgary's water Feb. 8, 2011, The Alex and other dental experts say dental decay in kids is worsening.

"These children are living in pain for months," said Denise Kokaram, Program Lead of the Dental Health Bus. "We are seeing children that are seven years old that have every tooth in their heads decayed."

Kokaram said the positive impact of the Dental Health Bus doesn't compare to adding fluoride back into the water.

Calgary dentist Larry Stanleigh lobbied city council to add fluoride to Calgary's drinking water. He said in a telephone interview that cavities are on the rise without it.007Andrea Chia, Registered Dental hygienist for The Alex Dental Bus gave a tour showing the inside of the fully-functionaly mobile dental clinic with two chairs, a certified sterilization area and a reception desk with a printer. Everything stores away in a particular place.

Photo credit: Kaity Brown

"Cavities have gone from little cavities to bombed-out teeth that we now have to remove," said Dr. Stanleigh, who estimates he made $150,000 more in fluoride-related fillings and dental work.

Those most affected are children under 15 and seniors over 65, said Dr. Stanleigh.

He says there has now been a terrible shift of cost to low-income Calgarians.

"I had a 50 per cent increase in the fillings that I did and thus a 50 per cent increase in the cost," said Dr. Stanleigh.

The History behind the 'Fluoride Debate'

Fluoride is a compound of fluorine and salts groups. It is found naturally, however, synthesized fluoride is what is used in drinking water, toothpaste and mouthwash.

The fluoride debate started in 1957, when Calgarians voted to oppose adding fluoride to drinking water. Citizens voted against fluoride two more times in 1961 and in 1971.

However, in 1998, the tables turned when a panel of experts, (Stanleigh was one of them), came to City Council with the proposition that adding fluoride, at the optimal level of 0.7 mgs, could have significant benefits to public health.

When it was put to a citizen vote, Calgarians voted in favour of adding fluoride to the water.

Fluoride levels between 0.1 to 0.4 milligramsoccur naturally in our water because of the Elbow and Bow rivers. So an expert panel proposed adding enough to reach the optimal level of 0.7 mgs. This motion then passed.

However, in 2011, Ward 7 Councillor Druh Farrell formally asked council to remove fluoride in a notice of motion. This time there was no expert panel consultation and no public vote on the issue.

Her motion was contrary to public health advice from the Alberta Health Services and several other organizations. Richard Musto, Calgary's medical officer with Alberta Health Services (AHS), told CBC in April 2011. 

"We believe the evidence is clear that communal water fluoridation — which is an adjustment of the normal level of fluoride — safely reduces cavities in the people who drink the water," Musto said on April 12, 2011. 

Stanleigh wrote an e-mail to city councilors imploring them to reconsider the decision of discontinuing fluoride, presenting evidence to the benefits it had for Calgary.

What other Agencies Think

Druh Farrell's Notice of Motion to Remove Flouride mentions that the Ontario Ministry of Health, the Centre for Disease Control and Prevention and the American Dental Association say that fluoridated water should not be given to infants, on the websites of each of these organizations, there is advocacy for the importance of proper fluoride consumption through the water supply.

The Ontario Ministry of Health released a statement from Dr. Arlene King in April of 2011 stating "As Chief Medical Officer of Health for Ontario, I am very concerned about the loss of fluoridated drinking water in certain communities in spite of consistent evidence that water fluoridation is safe and effective."

The article following outlines the benefits of water fluoridation, safety of fluoridated water and a section about the importance of good oral health for overall oral health.

Similarly, the Centre for Disease Control and Prevention stated "The proper amount of fluoride from infancy through old age helps prevent and control tooth decay. Community water fluoridation is a widely accepted practice for preventing and controlling tooth decay by adjusting the concentration of fluoride in the public water supply."

American Dental Association (ADA) policy states "The Association endorses community water fluoridation as a safe, beneficial and cost-effective public health measure for preventing dental caries (cavities). This support has been the Association's policy since 1950."

"I got seven aldermen emailing me back all stating that they had already made up their minds and that regardless of what was going to be presented to them, they were still going to be voting against it," he said

City Council voted 10-3 to remove fluoride from the water on Feb. 8, 2011. Voting in favour were Ward 7 Druh Farrell, Ward 10 Andre Chabot, Ward 3 Jim Stevenson, Ward 8 John Mar, Ward 11 Brian Pincott, Ward 13 Diane Colley-Urquhart, Ward 9 Gian-Carlo Carra, Ward 14 Peter Demong, Ward 5 Ray Jones, Ward 12 Shane Keating.

Opposed were Ward 4 Gael Macleod, Ward 6 Richard Pootmans and Ward 2 Gord Lowe.

According to the Notice of Motion, $750,000 was spent on fluoride. So Council then decided to split a one-time grant of $750,000 to two agencies: The Alex and Calgary Urban Projects Society (CUPS).

Most of the money, $585,000, went to The Alex with stipulation that it be put in an endowment fund and the interest used to fund a dental program.

The Alex used the city funds to help launch the Dental Health Bus in January 2013.

With AHS and the two school boards, 16 schools were identified for a pilot program, to provide sealant treatments for Grade 2 and 6 students. Last year, the Alex did the program in another 31 schools that were identified as high-need. This school year, the Alex is visiting 33 schools. In total, the Dental Bus has provided around 5,000 sealant treatments since it started.

The Calgary Urban Projects Society (CUPS) received the balance, or $165,000. Lorna Curran, Communications Manager for CUPS, says that it received the remaining $165,000 which financed a new dental clinic, staffed by volunteer dentists. CUPS hasn't seen the impact of the fluoride being removed because it began serving children only in 2012.

"Prior to that our services were limited to extractions for adults," said Curran in an e-mail.

Farrell still backs her no fluoride stance

Ward 7 Councilor Druh Farrell still stands behind her anti-flouride views.020The Dental Bus is a program from The Alex, a non-profit community health center. The bus travels to schools that have been identified as high-risk to provide dental care of sealants to help protect against cavities in the wake of the fluoride removal for Calgary's public water system.

Photo credit: Kaity Brown

Her office sent the following Nov. 2014 email: "The science is still developing on whether fluoride consumption is effective, and even if it is, whether the health risks of consumption outweigh any benefits." Scientific American published an interesting article in January 2008. The Globe and Mail published articles both for and against fluoridation. While the debate continues, Calgary has to ensure that Calgarians have access to safe, clean drinking water."

Farrell's main argument for the removal was that it was easier to try to help low income families than to try to "medicate" the entire population.

Both The Alex and CUPS say that the initial funding will need to be increased to keep up with the dental care demand. Although the city is saving $750,000 a year, it has not put that money back into the community dental health.

Alberta Health Services has countered by funding a study by Lindsay McLaren, associate professor at the University of Calgary. She is comparing dental health of students in Grade 1 and Grade 2 in Calgary with students in Edmonton, who still have fluoride in the water supply.

Results are expected in spring 2015.