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What Does the Science Say?

Community Water Fluoridation

Fluoride is a naturally occurring mineral found in soil, some foods, and nearly all water sources. In the mid 20th century, dentists discovered that people who lived in communities with higher levels of fluoride in the water had better dental health. Water fluoridation is a way to copy what nature does, where nature isn’t doing quite enough. Since it began in 1945, water fluoridation has expanded to serve hundreds of millions of people (including nearly 40% of all Canadians), and is one of the recognized advances in modern public health.

Almost all drinking water in Alberta contains natural fluoride. The levels range from 0.1 parts per million (ppm) to over 2.4 ppm (at which point the community must take action to reduce it). Fluoridation means adding and controlling fluoride level to a safe low amount (0.7 or 0.8 ppm) that benefits dental health. These small amounts do not affect the taste or quality of water.

Despite the known oral health benefits, water fluoridation has become a controversial topic in some communities, as some people have concerns about the safety or ethics of water fluoridation. There is an overwhelming amount of information about fluoridation, which gets over 2,300,000 'hits' when searched on Google. PubMed, the online library of health studies, finds almost 6,000 published research reports. Sometimes the same research is used to support and to oppose the issue.

Ethical and effective public policy must be based on the best evidence. Systematic reviews about fluoridation deliberately search for all studies, including ones about possible adverse effects. Systematic reviews look at the quality level of the research, and how much research has been done. Experts comb through published studies and select, read and rate each useful one.

Several systematic reviews about water fluoridation have been done in recent years:

In 2019, The Canadian Agency for Drugs and Technologies in Health (CADTH) completed a Health Technology Assessment on Community Water Fluoridation Programs. Consistent with the prior systematic reviews, CADTH concluded that “there is consistent evidence that CWF protects against dental caries in children and adults and leads to improved oral health outcomes with very uncommon and minor side effects, and that CWF programs are cost saving from a societal perspective.”

Dedicated to evidenced-based best practice, Health Canada, the Public Health Agency of Canada, Alberta Health, and Alberta Health Services consider new research regularly to develop their recommendations, guidelines, and position statements. The science supports fluoridation as safe and effective as a public health measure. Should research emerge to suggest that a change in practice should be considered, recommendations will be revised accordingly.