Last week, Ottawa unveiled a multi-billion dollar dental care initiative. Anticipated to cover nine million Canadians, it has been described as the largest expansion to public health care since the introduction of medicare.
We understand the political appeal of extending Canadians’ dental coverage, and are supportive of increased coverage for low-income Canadians and children. But it is unfortunate that the government would not focus on prevention as a more cost-effective and health-promoting strategy.
Currently, an astonishing 61 per cent of Canadians do not have access to fluoride-treated drinking water, according to a 2022 government report by the Office of the Chief Dental Officer of Canada. Fluoridation in British Columbia, New Brunswick, Newfoundland, Quebec and the Yukon is almost non-existent.
For a first-world country like Canada, this is nothing short of scandalous.
Community water fluoridation — which involves monitoring and adjusting fluoride levels in drinking water to the optimal level — is associated with an approximately 25 per cent reduction in tooth decay in children and adults, the 2022 report says. This in turn lessens the need for costly dental care and emergency hospital visits.
The cost of fluoridating water is also minuscule relative to the returns. The per capita annual benefit from fluoridation ranges from $5.49 to $93.19 for every dollar invested, with the returns increasing according to community population size, according to numerous studies. And these returns — measured in dollars and time saved from avoiding dental and medical visits — do not even factor in intangible benefits like pain-avoidance and enhanced quality of life.
There are, moreover, decades of scientific findings supporting that fluoridation at low levels is safe. Community water fluoridation is endorsed by major public health bodies around the world, and by the Canadian Dental Association and the Public Health Agency of Canada. It has been hailed by the US Centre for Disease Control as one of the ten greatest public health achievements of the 20th century. In the US, 73 per cent of the population had access to fluoridated water in 2020.
Given the strong protective effects, high return on investment and scientific consensus about its benefits, one has to wonder how an advanced country like Canada has not yet achieved fluoridation nationwide.
The problem, says Juliet Guichon, an associate professor at the University of Calgary’s Cumming School of Medicine, is that decisions about water treatment tend to be made at the local level.
Guichon knows. From 2017 to 2021, she led a campaign to return water fluoridation to Calgary, which had fluoridated its water from 1991 to 2011, and stopped doing so in 2011.
Municipalities are well-suited to making decisions about matters like roadways, public transport and zoning, Guichon says. But they tend not to be well-staffed for public health decision-making.
Calgary, for instance, voted 62 per cent in favour of returning community water fluoridation in 2021, but the voters’ wishes have still not been implemented. The city has committed to returning fluoridation in September 2024.
Another challenge is that small but vocal — and powerful — minorities can form to oppose fluoridation on health grounds.
“Opponents like to style fluoridation as though it is the introduction of a new and poisonous substance, when in fact it is a naturally occurring mineral like calcium,” said Guichon. “We need some but can’t have too much.”
While there are parts of the world where water fluoridation levels are dangerously high, this is not the case in Canada, she adds.
“As far as I know, there isn’t a source of water for a municipality in Canada that has too high fluoride. It’s more commonly the case that the fluoride is too low.”
Now that Ottawa has introduced a dental-care program, there is both a moral and financial imperative for governments at all levels to act together to achieve fluoridation treatment across the country. Failure to do so will unnecessarily increase the cost of the dental-care program and allow Canadians — particularly low-income Canadians — to needlessly suffer.
This is also an area where coordinated action among the federal, provincial and municipal governments is appropriate. Ottawa and the provinces share responsibility for health under the constitution. Given that Ottawa is footing the bill for dental care, it clearly has a role to play in minimizing costs.
Provinces, in turn, have the legal authority to make decisions for their entire province. They should introduce legislation that requires and supports municipalities in implementing community fluoridation treatment.
But as is the case with any public health decision, trust is essential. All governments will need to lead public education campaigns to raise awareness of the benefits and safety of fluoride-treated water.
There is a certain irony in the federal NDP having been so instrumental in getting Ottawa to implement a national dental care program. As Guichon points out, NDP leader Jagmeet Singh represents the people of Burnaby South, BC, where there is no fluoridation.
“It is sad and troubling when [Singh] takes credit for treatment when no child wants treatment,” Guichon said. “What is he doing locally to help the people he represents?”
We agree. On this matter, the national and local are inextricably linked. We must achieve community water fluoridation nationwide.
