City's Decision To End Fluoridation Looking Like a Mistake

My latest Calgary Herald column looks at the issue of water fluoridation and whether city council needs to revisit its 2011 decision:

Word last week about a worsening situation in Calgary with regard to  children’s oral health is certainly disconcerting, but sadly, not at all  surprising.
Trying to predict the implications of a particular government policy can be  an imprecise science. However, when it came to the 2011 decision by Calgary city  council to halt water fluoridation, the implications were actually fairly easy  to predict.
It remains unclear what benefits council expected we’d realize. Frankly, the  decision was about as puzzling as any we’ve seen in recent memory. Water  fluoridation had been approved by voters in 1999, and the practice was in  keeping with the best medical and scientific advice.
The evidence is pretty clear on water fluoridation, which the U.S. Centers  for Disease Control and Prevention has listed as one of its 10 greatest public  health achievements of the 20th century. As Alberta Health Services notes on its  website, three major systematic reviews of the available evidence have been  conducted over the past decade in three countries. All of them demonstrate quite  convincingly that water fluoridation is effective in reducing cavities and that  the practice is safe.
So not only was the 2011 city council decision a solution in search of a  problem, it was a “solution” directly at odds with the best evidence. There’s no  harm in examining or reconsidering certain policies, but it’s not unreasonable  to expect that the conclusions that follow be evidence-based.
That’s not to say that fluoridation is a panacea. For example, University of  Iowa dental professor Stephen Levy, who has been involved in a long-running  study of water fluoridation, has suggested that the benefits of fluoridation are  not as great today as they were, say, 30 years ago. While there may be other  sources of fluoride available, and other means of addressing oral health, water  fluoridation remains a cost-effective means of reaching the populace.
There is also concern around fluorosis, the slight discolouring of teeth that  can occur from the overconsumption of fluoride. However, many experts believe  swallowing toothpaste is a bigger factor in fluorosis than fluoridated water,  and in any event, it’s not at all clear whether Calgary’s decision to end water  fluoridation has had any impact on rates of fluorosis.
It is becoming apparent, however, that the decision to end water fluoridation  has had precisely the sort of impact that many health professionals feared it  would: namely, children in Calgary suffering from more and bigger cavities.
The alarm bell was sounded last week by the Alberta Academy of Pediatric  Dentistry, which has noted the disturbing trend over the past two years. They’re  hoping that these alarming statistics might prompt city council to take another  look at the matter.
To make matters worse, not only were these experts ignored in the decision to  end fluoridation, these same experts are being ignored in the development of  alternative dental programs. The $750,000 the city spent annually on  fluoridation was earmarked for new oral health programs aimed at low-income  children and families. It’s certainly fair to study the most effective means of  spending that money, but two years later, it seems quite clear that we’re  getting far less bang for our buck.

For her part, Ald. Druh Farrell — who spearheaded the anti-fluoridation push  on council — claims that this is not a Calgary problem, and that cavity rates  are rising across North America. Of course, this ignores the very specific trend  in Calgary being identified by dentists, and it ignores the fact that Edmonton —  which started fluoridation long before Calgary did, and continues to do so — has  lower cavity rates.
Farrell has also decided that the issue “is over,” which is rather  disingenuous on her part.
Just as the 1999 plebiscite was not the final word on the matter, nor should  the 2011 council vote be. As with any other government program or policy, we  should look to see what impact it is having.
The evidence that council made a mistake in 2011 is strong and compelling. If  this current council is too stubborn and intransigent to at least acknowledge  that possibility, then hopefully the fall election will give us a slate of more  open-minded and evidence-friendly aldermen.