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Canadian Public Health Association

Protect your teeth!

Jennifer Lindsay


No one likes the drilling and filling needed to repair a cavity, especially not children. Unfortunately, despite it being largely preventable, dental decay is the most common chronic disease for children, with 57% of those aged 6-11 years and 59% of youth 12-19 years having had a cavity.1 Several approaches are available to prevent cavities, ranging from regular brushing and flossing to more complex approaches, including the use of sealants, which must be applied by a dental professional. According to US data, the cost of sealant in 2002 was $27 per tooth, payable through extended health insurance or as an out-of-pocket expense.2 In the US, school sealant programs have been implemented and this strategy has been effective when targeted towards high-risk populations (children who have already had a cavity filled). Sealants, however, require 4-6 years of application before being cost-effective.3,4

Fluoridation is another method of preventing tooth decay. The fluoride ion reinforces the enamel after the tooth has surfaced, making it more resistant to decay. In fact, each dollar invested in fluoridation can save approximately $38 in dental treatment.5 It’s not a panacea, as excessive concentrations of fluoride will cause dental fluorosis in children, an adverse aesthetic effect.1 However, only 12% of Canadian children aged 6-12 have fluorosis, much of which is classified as very mild (sporadic white specks on the tooth surface) and causes no impairment to the tooth’s function.1 Moderate or severe fluorosis is the stage at which significant changes to the tooth’s appearance and possible functional impairment are seen; yet, so few Canadians experience this stage, it has not been reported.1

Fluoride can be applied by using products such as toothpastes, rinses, lozenges, chewable tablets, drops and mouthwashes.6 Alternatively, gels, foams or varnishes can be applied by a dental professional.6 Municipally fluoridated water, however, may be a better approach as it is accessible to the entire population and no personal behaviour change is needed in order to benefit from the protection.5 Brantford, Ontario was the first Canadian municipality to fluoridate its water, starting in 1945.7 Today, 45% of Canadians have access to fluoridated water, with Ontario having the greatest percentage of the population with access (75.9%).8 Systematic reviews consistently conclude that municipal water fluoridation has a great return on investment; yet, more than 30 Canadian municipalities since 2005 have discontinued its use.9

The benefits of fluoridation were further demonstrated in a recent case study that examined dental caries rates from 2004/2005 to 2013/2014 in Edmonton and Calgary. Water fluoridation started in Edmonton in 1967 and continues today, whereas Calgary started the practice in 1991 and ended in 2011.7 The rationale for the latter decision included: cost savings (expected to be $750,000/year), unknown long-term effects of fluoridation, and general concerns expressed by constituents.10 Overall, the study showed that in Calgary there was an increase in dental caries in children’s primary teeth.9 In permanent or adult teeth, specifically on smooth surfaces, there was also a trend towards greater tooth decay.9

The positive impacts of water fluoridation have been demonstrated for over 60 years. It prevents and even reverses early signs of tooth decay when used properly and consistently.5 The Canadian Dental Association considers fluoride treatment to be the most important measure to maintain oral health for all Canadians.6 When there is this kind of evidence-based support for the measure, public health professionals need to be asking: why are municipalities deciding to stop fluoridating their drinking water?

  1. Health Canada. Summary report on the findings of the oral health component of the Canadian Health Measures Survey, 2007-2009. Ottawa, ON: Health Canada, 2010. Available at: (Accessed June 2, 2016).
  2. Azarpazhooh AM, Main PA. Pit and fissure sealants in the prevention of dental caries in children and adolescents: A systematic review. Ottawa: Canadian Dental Association, 2008. Available at: (Accessed June 30, 2016).
  3. National Institute of Dental and Craniofacial Research. Community and other approaches to promote oral health and prevent oral disease. Bethesda, MD: NIDCR, National Institutes of Health, 2014. Available at: (Accessed June 6, 2016).
  4. Weintraub JA, Stearns SC, Burt BA, Beltran E, Eklund SA. A retrospective analysis of the cost-effectiveness of dental sealants in a children’s health center. Soc Sci Med 1993;36(11):483-93.
  5. University of Toronto Faculty of Dentistry. Water fluoridation: Questions and answers. Toronto, ON: University of Toronto, 2012. Available at: (Accessed June 2, 2016).
  6. Canadian Dental Association. Use of fluorides in caries prevention. Ottawa: CDA, 2012. Available at: (Accessed June 24, 2016).
  7. Ontario Dental Association. Community water fluoridation. Ottawa: ODA, 2015. Available at: (Accessed June 1, 2016)
  8. Rabb-Waytowich D. Water fluoridation in Canada: Past and present. 2009. Available at: (Accessed June 2, 2016).
  9. McLaren L, Patterson S, Thawer S, Faris P, McNeil D, Potestio M, Shwart L. Measuring the short-term impact of fluoridation cessation on dental caries in Grade 2 children using tooth surface indices. Community Dent Oral Epidemiol 2016;44(3):274-82.
  10. Gerson J. Fluoride increasingly removed from water supply despite lack of evidence it is harmful. National Post 2013 May 24. Available at: (Accessed June 6, 2016).

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