Do you know if your tap water is fluoridated? Since Brantford, Ontario began fluoridating their water supply in 1945, community water fluoridation has been a widely used and successful public health measure in Canada for over 70 years. In fact, the U.S. Centre for Disease Control considers it one of the ten greatest public health achievements of the 20th century. However, recent studies have raised concerns about the safety of fluoride, particularly in relation to cognitive development. A recent study published in the Journal of the American Medical Association (JAMA) reported that exposure to fluoridated water during fetal development was associated with lower IQ scores of Canadian children.
While the benefits of fluoride in preventing tooth decay are well established, the stance of Canadian cities on community water fluoridation has fluctuated in the last decade. Windsor removed fluoride from its drinking water in 2013 but has added it back to the local drinking water system in 2022. Similarly, Calgary discontinued its fluoridation program in 2011 but plans to bring it back in 2024. Today, approximately 73% of the US population has access to fluoridated water, and in Canada, the percentage is around 38.7%. This raises the question of whether we should continue drinking water with fluoride.
Researchers are still divided on the issue, and more cohort studies are underway to bring clarity to the debate. Two key problems emerge in this discussion. First, is it worth investigating whether water fluoridation works for cavity prevention as it did in the past? With the popularity of fluoridated toothpaste and other supplements in recent decades, some may argue that adding low doses of fluoride is unnecessary for oral health. Dentists in the US have found that water fluoridation leads to only one fewer cavity in baby teeth, and about 0.3 fewer cavities on average in adults in fluoridated areas, which is not as much as people might expect. Additionally, most European countries have discontinued water fluoridation but have still experienced substantial declines in tooth decay, which makes the possible negative health impacts on cognitive abilities far more important.
Secondly, neurotoxicologists and dental public health researchers have been talking past each other, and a neutral discipline is necessary to dispassionately discuss the evidence. Drinking fluoridated water in the early childhood could be one of the significant determinants of human resource development and may potentially cause economic disparities. Swedish health economists have examined the long-term effects of fluoride exposure on people’s outcomes in the labor market. They found that fluoride has no negative effect on cognitive ability but a positive impact on earnings. There are thousands of articles pointing to the safety of community water fluoridation, and economic research can contribute to the debate with evidence of causality using economic techniques.
In conclusion, it is crucial to balance the benefits of reducing tooth decay with any potential risks associated with fluoride exposure to ensure that public health policies are evidence-based and effective. I believe economic research can offer a neutral and objective perspective and assist policy makers in attributing causality.
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