The Fluoridation of Drinking Water: 2013

What exactly is fluoride? It is an ion that comes from element number 9, fluorine. Fluoride is a natural mineral that can be found in many different places. It can be found in soil, air, plants, animals and in water. When hearing the word “fluoride” many people think of that flavoured mouthwash you receive when you go to the dentist. Fact is that many dental products such as toothpaste, contain the fluoride ion. In addition, fluoride is commonly added to water because of its effects on dental health. The most common additive is fluorosilicic acid. It both strengthens and protects the tooth enamel to help resist tooth decay.

Fluoridation in the City of Toronto

In order to reduce the risk of dental cavities, fluoride is added to treated water in Toronto, Ontario. In the City of Toronto, luoride is seen as a key ingredient in safe, quality water. This is advised by Toronto Public Health. Toronto keeps inside of the Health Canada Guidelines to maximize the dental health of citizens and minimize the concern of over exposure.

Fluoridation in the Town of Innisfil

I sent in a inquiry to the town of Innisfil regarding the fluoridation of their water systems. I received an email after just a few hours from Anne Musshe, the Administrative Coordinator for the water systems of Innisfil. She responded, stating that fluoride is not currently added to the water in Innisfil, for the simple reason that "it is not mandated by the Ministry of the Environment for water treatment." (from Anne Mussche's email).

Fluoridation in the City of Barrie

Due to the referendum that occurred back in the 1960's, the citizens of Barrie voted that fluoride should not be an additive to drinking water. It is believed by these citizens that fluoride “...is not an important aspect of having quality tap water.” (Frequently Asked Questions Retrieved May 23, 2013, from http://www.barrie.ca/Living/Water/Operations/Pages/GeneralInquiries.aspx)

Arguments Against the Fluoridation of Drinking Water

Arguments Against Water Fluoridation:

dental flurosis
skeletal fluorosis
costly
time consuming
not required
food and drinks already contain fluoride
there are other ways to prevent tooth decay
not a health necessity
can be harmful to health if used in excess
fluoridated countries do not have less tooth decay than those without fluoridation
affects many tissues besides the teeth (brain, thyroid gland, and one's blood sugar
fluoride over-exposure can be seen in 40% of American teens

Chemistry of How Fluoride Prevents Tooth Decay and Other Advantages

Outer tooth enamel tends to decay before the inner, due to the fact that it is exposed. The outer enamel contains more fluorine than the inner so that it is fortified. Teeth need to be repaired with fluorine, that is where the fluoridation comes in. It protects the tooth from decay. Enamel is porous, so when bacteria enters and excretes acids, it breaks down the calcium and phosphorus.

Ca₅(PO₄)₃OH= calcium hydroxylapatite - the most main component of tooth enamel

H₂SiF₆= hydrofluorosilic acid - most common compound used in fluoridation, when put through a series of reactions, it becomes SiF4 .

When SiF4 is added to water, it dissolves, isolating the fluoride ion:

SiF_4
(aq) → H₂O → Si⁺⁴ _(aq) + 4F^– _(aq)

When the fluoride ion reacts with tooth enamel, it replaces the hydroxide:

Ca₅(PO₄)₃OH _(s) + F ^– _(aq) → Ca₅(PO₄)₃F _(s) + OH ^– _(aq)

The bacteria that causes tooth decay release acids that break down the enamel. As the fluoride fortifies the enamel, the hydroxide neutralizes some of the acid. This neutralization, however, is short lived, seeing as the water is then swallowed.

Stakeholders

On Tuesday, May 28th 2013, I had an interview with the head hygienist, Lisa, at Beach Road Dental in Innisfil, Ontario. We discussed her opinion and Dr. Shelley Patton's (professional dentist at Beach Road Dental) opinion on the fluoridation of drinking water. One thing she said really stuck out to me:

"Fluoride is a great thing when used properly."

Lisa then went into further detail, explaining why both her and Dr. Shelley Patton are against the idea of fluoridating drinking water. She said that one source of fluoride is adequate. Fluoride is naturally occurring foods, drinks, and you receive fluoride at dental check-ups. The ingestion of too much fluoride leads to something called fluorosis. Lisa then said:

"Fluoridation is not needed is fluoridated toothpaste is used. This leads to fluorosis."

I was also informed that even where there is no fluoride added to the water, patients often come in with fluorosis. For example, Lisa says she sees many patients in Innisfil with fluorosis.

The ingestion of fluoride can also lead to something called skeletal fluorosis. The fluoride travels throughout the body and when it reaches the bones, does the same as it would do to the teeth. I was the told that this is why the dentists advise that children use toothpaste without fluoride, because children tend to swallow their toothpaste.

Other Stakeholders:

doctor (skeletal fluorosis) – when patients go for x-rays, doctors may notice a difference in the appearance of the bone. This would lead to more frequent visits.
those in water treatment jobs – extra steps are required to add the compound from which the fluoride ion comes from.
Citizens – despite the fact that fluoride provides citizens with the prevention of tooth decay, fluoride can greatly affect all members of the family. Parents can control what they use in terms of the purchase of items with fluoride (toothpaste, mouth wash, etc). Children however, use what they have. They are not aware of the threats and results of using fluoride. Parents buy children non-fluoridated toothpaste to reduce their intake of fluoride. Adding fluoride to the water also costs money. This would raise one's taxes.
animals do not have an opinion, however, they too are affected by water fluoridation. The most affected animals are livestock, mostly cattle. Their bones and tissues are affected in a negative manor.

History of Fluoridation of Drinking Water

Water fluoridation began in the early 1900's with a dentist from Colorado, Dr. Frederick McKay, noticed that a lot of his patients had brown staining and enamel mottling on their teeth. Him and his colleague, Dr. G. V Black, researched for years. They soon discovered that the individuals who had this staining and mottled enamel were resistant to tooth decay.

By the 1930's, they discovered that those who's water had high levels of natural fluoride had this staining. This led to the name "Colorado Brown Stain" which is now known as moderate-severe dental fluorosis.

In 1939, a man by the name Dr. Gerald J. Cox and his associates made the proposal of adding fluoride to the water to prevent tooth decay.

The first city in the world to make its water fluoride level to 1 ppm was Grand Rapids, Michigan. The first city in Canada to make this adjustment was Brantford, Ontario. Over the course of seven years, the dental and medical statuses were compared between two cities in Ontario (one with fluoridated water, the other without) using clinical trials. The results from the clinical data were so impressive, other cities began to fluoridate, before the classical trials were completed.

Over 400 million people throughout the world have fluoridated water, and 75.9% of the population of Ontario have fluoridated water.