As Calgary votes for fluoride, some have hope B.C. could do the same

EDITOR'S NOTE: This story has been updated in response to a review by the CBC Ombudsman.

After a year that saw both Regina and Calgary voting to add fluoride to their drinking water, some British Columbians are wondering whether it's time for cities in the province to finally consider fluoridation.

About two-thirds of Calgarians who voted in Monday's plebiscite supported the fluoride measure — hopeful news for Dr. Mario Brondani, an associate professor of dentistry at the University of British Columbia and a self-described "passionate advocate for fluoride."

"I think it's time that we perhaps could have this conversation again," he told CBC News.

The Calgary fluoride vote is part of a recent trend. Regina's city council made the same decision this summer, and fluoride is expected to return to the Ontario city of Windsor's water this fall.

Fluoride has never been added to Metro Vancouver's drinking water. In fact, Health Canada estimated that 98 per cent of British Columbians lived in communities without fluoridated water as of 2017.

That's despite decades of research showing that fluoride strengthens tooth enamel, making it more resistant to the acid that causes cavities, and carries little risk to people's health, Brondani said.

For Brondani, it's not just an issue of oral health — it's also about equity in a country where dental care is expensive and very little of it is covered by the public health system.

While many people in B.C. are able to access coverage for dental care through the insurance provided by their employers, those who depend on income or disability assistance are afforded just $1,000 of coverage every two years, even though they tend to have the greatest need for dental care, Brondani said.

"People might say that in Vancouver or in Canada, caries [or cavities] are not that prevalent in our children," he said.

"Well guess what? It is not prevalent in affluent neighbourhoods or affluent families, but it is very prevalent in those that do not have access to care."

A report from the Urban Public Health Network suggests the rate of dental surgery was 60 per cent lower for children in Canada's richest neighbourhoods from 2011 to 2015.

Tooth decay linked to other health problems

Those sentiments are shared by Joan Rush, chair of the advocacy committee at the Canadian Society for Disability and Oral Health.

She said dentists in B.C. aren't required to train in treating patients with disabilities and complex medical conditions, which makes it difficult to access appropriate care. 

Meanwhile, people living in rural, remote and Indigenous communities often don't have reliable access to any dentists at all, resulting in higher rates of decay and tooth loss.

"The most common reason for day surgery among children in British Columbia is dental surgery, because again, we don't fluoridate our water and kids develop cavities," Rush added.

Rush also points out that dental decay can lead to other problems — it's associated with a higher risk of heart disease and can lead to serious infections.

A study released earlier this year on the effect of removing fluoride from Calgary's water in 2011 showed that seven years after that move, Grade 2 students in the city were significantly more likely to have cavities than children in Edmonton, where the water remained fluoridated.

When Brantford, Ont., became the first city in Canada to fluoridate its water in 1945, there was a 54 per cent drop in tooth decay among eight-year-olds, according to the Canadian Public Health Association.

Decades of debate about fluoride

Fluoridation is part of a long-running debate for the Vancouver area. The city held a plebiscite in 1968, and while just over half of voters supported fluoridation, it was not enough to see the measure enacted.

In a 1976 CBC Radio report on the issue, then-medical health officer Dr. Gerald Bonham described Vancouver as the "rotten tooth capital of Canada."

Some of the candidates in that year's civic election were running on explicitly anti-fluoride platforms, and members of the Stop the Fluoridation Committee told CBC that fluoride advocates were trying to poison the public as part of a shadowy conspiracy that somehow involved the mining firm Alcan.

Back then, opponents of fluoridation were raising concerns about cancer, but numerous studies have failed to support a link. Today the arguments are more likely to focus on discomfort about additional chemicals in drinking water.

Brondani said that while it's possible for fluoride to be toxic to humans, the same could be said of any chemical — including water itself.

He explained that the recommended concentration of fluoride in public drinking water is about 0.7 milligrams per liter. Fluoride becomes toxic to humans at a concentration of about 5 milligrams per kilogram of body weight.

"You would have to drink thousands of gallons of water a day," he said.

B.C.'s rates of tooth decay have shown signs of improvement in recent years.

A 2019 report on oral health among kindergartners across the province showed a "modest" improvement over the past decade, noting that 69.2 per cent children surveyed that year were cavity-free. However, that figure dropped to 50 per cent among Indigenous children.

In that report, Vancouver had an above-average rate of cavity-free schoolchildren.

'A lack of active support' from public officials

Inder Singh, the director of interagency projects and quality control for Metro Vancouver's water services, confirmed there is a "a preference to minimize the use of chemicals in the water treatment processes" as well as "a lack of active support for fluoridation from health authorities, elected officials and the public."

In a written statement emailed to CBC News, he said fluoridation hasn't been recommended for Metro Vancouver to date because it's not required to meet water quality standards and updating water treatment systems would entail additional costs.

Rush still believes change is possible, if officials like Provincial Health Officer Dr. Bonnie Henry get on board.

"If it was promoted by that office and adopted by the minister of health, the premier, I think that we could really go some distance," she said.