Water fluoridation : an analysis of the health benefits and risks

The purpose of water fluoridation is to prevent dental disease. Major international organizations such as the WHO and the CDC consider fluoridation to be a safe and effective public health measure to prevent tooth decay. Although health organizations largely concur on the safety of fluoridation, a small number of studies do raise questions concerning the link between fluoride and certain health problems. Consequently, in order to offer the population the benefits of water fluoridation, while minimizing potential problems, the INSPQ (Quebec public health institute) has taken into account Quebec’s public health risk management framework, the Cadre de référence pour la gestion des risques pour la santé dans le réseau québécois de la santé publique, in developing its recommendations.

The INSPQ produced this advisory taking into account its mandate to improve health risk management practices (90). Quebec’s public health risk management framework is designed to serve as a guide to public health professionals with respect to risk management and informed decision making. Its content is meant to be sufficiently broad to apply to a wide range of situations. However, it should not be seen as a “recipe book.” The guiding principles it presents are meant to provide a framework for making decisions concerning water fluoridation. The seven guiding principles in this document are : empowerment of the community, equity, openness, the primacy of human health protection, prudence, scientific rigour, and transparency.

The INSPQ believes that the MSSS (Quebec department of health and social services) and its network should continue to build on these principles, which already guide the activities of public health professionals who are involved in the promotion of water fluoridation, in order to ensure a high level of quality, as well as compliance with ethical and scientific principles.

Overall, the scientific data currently available does not show that water fluoridation at concentrations deemed beneficial to dental health is harmful to humans. Nor have environmental studies revealed any harmful ecosystemic effects of fluoridation. It is important to note, however, that the vast majority of scientific reviews on fluoride have found methodological weaknesses in the epidemiological studies published to date. Consequently, such research needs to continue and must be improved from a methodological standpoint.

Water fluoridation is the safest, most effective and most economical public health measure for preventing and reducing dental caries. It benefits all citizens, regardless of their level of education, socio-economic status, age or ethnic background. Everyone can benefit from water fluoridation, especially the most vulnerable members of our society. Despite a lack of recent data on the prevalence of dental caries in Quebec children, the fact that the percentage of kindergarten children considered at risk for tooth decay has not declined in recent years suggests that current prevention methods are failing to reach the more vulnerable segments of the province’s population.

Public health professionals have a responsibility to inform the public about the health benefits of fluoridation, the potential risks associated with this practice, and the measures taken to minimize such risks. Clear and transparent communication is one important success factor. The Institute’s recommendations are consistent with those of major groups of international experts who continue to view fluoridation as an important public-health measure. Still, Quebec lags far behind the rest of North America in the implementation of this public health measure, and would have to undertake fluoridation throughout the province to attain a fluoridation status comparable with most other states and provinces. In other parts of the world, nations are fully committed to drinking water fluoridation or have adopted other means to increase their citizens’ intake of fluoride. Fluoridated salt is one such option. Since the present document deals only with the fluoridation of drinking water, no scientific review of these other solutions was undertaken. However, even if we were to review these other options, the advantages of water fluoridation would in no way be diminished.

Christian Fortin
Institut national de santé publique du Québec
André Lavallière
Agence canadienne d’inspection des aliments
Dental health
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