TECUMSEH — What should come out when you turn on your tap? Like many across southwestern Ontario, residents of Tecumseh get non-fluoridated drinking water, but that could change: the town’s council plans to vote on whether fluoride should be added. The outcome is far from certain — but, whatever happens, the decision will also affect people living outside the town’s boundaries.
In favour of fluoridation is a robust body of scientific evidence, says David Stevenson, president of the Ontario Dental Association. Fluoride prevents cavities in children and fosters better dental health in the elderly. He notes that the practice is supported by the World Health Organization, which states that “it is a priority issue to encourage national health authorities to implement effective fluoride programmes for prevention of dental caries.” Health Canada supports it as well: “Community water fluoridation has been proven to be a safe, effective and equitable way to prevent and reduce tooth decay (including root decay) for people of all ages — from children to seniors.”
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Those opposed say that too much of the chemical can cause fluorosis, a condition that discolours teeth, and skeletal fluorosis, a condition that can create brittle bones. They also question the safety of the form that’s added to the water supply. Kimberly DeYong, a councillor in the town of Kingsville and the director of Fluoride Free Windsor-Essex, a local group that campaigns against water-system fluoridation, claims that it is “actually hazardous waste from the agricultural industry that comes with arsenic and lead.”
Health Canada does confirm that the ingestion of high levels of fluoride is associated with the development of conditions such as skeletal fluorosis — but, in a 2010 report, it notes that, for decades, there have been no cases in Canada that can be linked to community water fluoridation and that insufficient evidence exists to connection to fluoride ingestion with other conditions such as cancer or immunotoxicity.
“Health Canada continues to monitor new research and would recommend appropriate changes to its guidelines should any health risks to Canadians be identified,” wrote André Gagnon, a spokesperson for the department, in an email to TVO.org.
And while the type of fluoride added to water (hydrofluorosilicic acid) is made from phosphate rock — also used in fertilizer — the Ontario Ministry of the Environment and Climate Change requires that water systems use only products certified by NSF International and the American Standards Institute. The combined standards are more stringent than those applied to the types of fluoride used in pharmaceuticals, according to Lambton Public Health and the City of London.
NSF International, based in the United States, says that fluoride used for water systems does contain traces of arsenic and lead, as well as several other contaminants, but that sampling conducted in recent years has not found these at levels that exceed its standards, which are far below the tolerance levels used by the U.S. Environmental Protection Agency.
“People who don’t want fluoride in the water, they’ve been questioning every study, every [bit of] research that’s been done,” says Wajid Ahmed, medical officer of health for the Windsor-Essex County Health Unit. “Community water fluoridation has been ongoing for more than 70, 75 years. We have good data. We have good evidence to show the benefit of how community water fluoridation helps in preventing many of these oral-health concerns.”
The issue is heading to the Tecumseh council because Windsor, the source of the town’s water supply and that of nearby LaSalle, voted in December in favour of fluoridation and instructed staff to make the necessary preparations (the next step is to pass a bylaw legislating fluoridation). But provincial legislation says the city can proceed only if one of Tecumseh or LaSalle support the decision. Council is divided.
For Tecumseh’s mayor, Gary McNamara, the choice is easy. “I’m certainly not one that will depend on folks that looked through the internet and will cherry-pick issues,” he says.
Deputy mayor Joe Bachetti voted for fluoridation in 2003 but voted against it a decade later when his municipality weighed in on (and supported) Windsor’s decision to de-fluoridate. This time, he’s not sure which way he’ll go.
“There’s a solid argument on both sides,” he says. He wonders who would pay for fluoridation — would his municipality have to increase taxes to pay for an increase in water costs? — and the ethics of pushing it on unwilling constituents. (Enwin Utilities, the Windsor-owned company that supplies the water, says it will cost $850,000 to install the equipment and $150,000 annually to fluoridate the water. Windsor’s operating budget for 2018 was approximately $800 million.)
Nearly three-quarters of Ontarians drink fluoridated water, but, in recent years, several municipalities have revisited the practice after being lobbied by those who oppose it. Thunder Bay opted out in 2009. Waterloo dropped it in 2010. (Three municipalities in Essex County — Essex, Kingsville, and Leamington — have never had fluoridated water.)
Windsor did the reverse after the Windsor-Essex County health unit asked council to reconsider its stand. A study produced by the health unit last year showed that oral health in the area was in steep decline. Since the chemical was removed in 2013, the study says, tooth decay and cavity levels have spiked. From 2011 to 2017, the percentage of the population that was cavity-free dropped 10 percentage points.
On Monday, Windsor council will vote on a bylaw that would legislate fluoridation; Helga Reidel, CEO and president of Enwin, told TVO.org she anticipates that it will pass. But provincial legislation makes clear that the majority has the final say: if both Tecumseh and LaSalle decide against fluoridation, the city won’t be able to act on its bylaw. That’s what happened to Sarnia when its council voted to de-fluoridate in 2013, but neighbouring municipalities wouldn’t agree. Today, Sarnians still drink fluoridated water.
Bachetti would prefer that the Ontario government make the decision for everyone. But there’s no indication that the province intends to do that. Hayley Chazan, press secretary for Health Minister Christine Elliott, told TVO.org via email that the ministry supports the practice and that the “government continues to monitor and review new and emerging evidence on community water fluoridation.” (In 2016, the Liberal government supported a resolution to amend legislation so that municipalities would be prevented from de-fluoridating, but the resolution was non-binding and did not result in further action.)
Tecumseh council was expected to vote on the issue in February but decided to defer it until after the Windsor council vote; LaSalle has done the same.
For McNamara, the issue comes down to peer-reviewed science and listening to those who understand it best — medical officers of health and dentists. He recalls a member of council asking experts what the next-best strategy would be for protecting oral health: “And the answer from the experts was, ‘There isn’t one,’” he says. “This is the best way of making sure that all our constituents are protected.”
This is one in a series of stories about issues affecting southwestern Ontario. It's brought to you with the assistance of faculty and students from Western University’s Faculty of Information and Media Studies.
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