Nov 4th 2013

1. Developed by:
Fluoride and Oral Health Focus Group
October 2013

2. “An overwhelming body of
reputable scientific evidence
attests to the safety and
effectiveness of community
water fluoridation.”
Dr. Paul Andrews SOHP Annual Conference 2013

3. • Community water fluoridation (CWF) has been identified by the
Canadian Public Health Association as one of the twelve great
public health milestones in the past 100 years
• The use of fluoride in the prevention of tooth decay continues to be
endorsed by over 90 national and international professional health
organizations, and is advocated by Saskatchewan's Medical Health
Officers
Saskatchewan Ministry of Health’s Position Statement
on Community Water Fluoridation
http://www.health.gov.sk.ca/Default.aspx?DN=2b8566d8-567e4276-8b21-6c6cf3f87639
Additional Position Statements on Fluoride
http://oralhealthalberta.ca/wp-content/uploads/2011/11/WF-Position-Statements.pdf

4. Dental Health of Grade 1 and Grade 7 Saskatchewan Students
by access to community water fluoridation 2008 - 2009
Fluoridated
Saskatchewan
Communities
Non-fluoridated
Saskatchewan
Communities
1.61
2.48
Cavities Present
13.5%
24.4%
Cavity-free
58.1%
43.9%
Average
deft/DMFT

5. Every $1 invested in adding
fluoride to drinking water saves
$38 in dental care.
Return On Investment = 3700%
http://www.youtube.com/watch?v=TVZxtuZhN_M

6. Fluoride Expert Panel Recommendations 2008
• Optimal amount 0.7 mg/L - p.p.m.
• The MAC (Maximum Allowable Concentration) is 1.5 mg/L
To adopt a level of 0.7 mg/L as the optimal target concentration
for fluoride in drinking water, which would prevent excessive
intake of fluoride through multiple sources of exposure
The current (MAC) of 1.5 mg/L of fluoride in drinking water is
unlikely to cause adverse health effects, including cancer, bone
fracture, immunotoxicity, reproductive/developmental toxicity,
genotoxicity, and/or neurotoxicity (Intelligence Quotient - IQ)

7. • Water fluoridation has a proud sixty year history in Saskatchewan
• Moose Jaw was the first Saskatchewan city to fluoridate, in 1952
Provincial Estimates for Community Water Fluoridation
Province
Total
Population
Population
With CWF
Population
Without
CWF
Percent
With CWF
Percent
Without CWF
Alberta
(2007)
Saskatchewan
(2010)
Manitoba
(2009)
Canada
(2007)
3,290,350
2,457,406
832,944
74.7%
25.3%
1,036,285
372,236
664,049
36%
64%
1,214,403
920,800
293,603
75.8%
24%
31,611,911
14,258,078
17,364,803
45.1%
54.9%
Source: Provincial or Territorial Environment Ministries, Dental Directors of each Province, Ministries of Environment. Dental Health Promotion Working Group of Saskatchewan.

8. http://www.health.gov.sk.ca
/SK-community-fluoridedata-2010

9. The Ugly
Truth…

10. 2010 CWF Status in Saskatchewan
58 communities were fluoridating in 2010
48 communities with optimal level of CWF
(.7 mg/L) in 2010
2013 CWF Status in Saskatchewan
36 communities are actually fluoridating in 2013
18 communities with optimal level of CWF
(.7 mg/L) in 2013

11. Since 2010 these communities have officially discontinued CWF:
Meadow Lake (July 2011)
Melville (May 2012)
Rosetown (May 2012)
Watson (March 2012, too expensive)
Wynyard (Too expensive)
Since 2010 two communities reinstated CWF:
Naicam (March 2012)
Prince Albert (Feb 2013)

12. Community Water Fluoridation Status 2013
*Reinstated since 2010
Red = less than optimal Green = optimal or more

13. As of January 2013 these communities are NOT fluoridating but have not
officially discontinued. They state they will continue but presently are
experiencing equipment related difficulties etc:
Langenberg
Moose Jaw and communities it serves (Baildon Colony)
Luseland
Saskatoon and communities it serves (Aberdeen, Allan, Bradwell, Clavet,
Dalmany, Elstow, Hague, Martensille, Osler, RM Corman Park, St. Isidore
de Bellevue, Warman)

14. Fluoridating but not to optimal levels:
Balgonie
Carnduff
Canora
Kindersley
Swift Current
Wadena
Weyburn (McTaggart)
La Ronge
Wakaw and communities it serves
(Annaheim, Bruno, Cudworth, Domrey,
Humboldt, Lake Lenore, Muenster, St
Louis)

15. Fluoridating to optimal levels:
Assiniboia
Eston
Gull Lake
Indian Head
Melfort and communities it serves
(Beatty, Gronlid, Kinistino, RM of
Kinistino, Star City, Star City Colony,
Weldon)
Moosomin
Naicam
Outlook
Prince Albert
Quill Lake
Tisdale

16. Some communities in Saskatchewan have
adequate naturally occurring fluoride levels
in their community water supply

17. The SDPHN has approached MHOCOS for
assistance with this issue

18. The majority of Canadians know about and support the idea of community
water fluoridation yet we are experiencing downward trends in CWF
Support Community Water Fluoridation. Encourage communities which are
planning to upgrade water systems to consider community water fluoridation

19. So Why the Downward Trend?
Anti-Fluoride Movement
• There are passionate people that actively oppose fluoride
• They are well organized
• Their views are based on opinion rather than facts which can be
dangerous
• Even though there is strong scientific based research that totally
contradicts their opinions… they, are being heard.

20. • We must be confident in our views and willing to express them
• Be familiar with the arguments and ready to respond to them
• Don’t get over technical
Here are a few sites to check out for more information:
When public action undermines public health: a
critical examination of antifluoridationist literature
Jason M Armfield
http://www.anzhealthpolicy.com/content/4/1/25
Suggested responses to antifluoridationist arguments
http://www.anzhealthpolicy.com/content/4/1/25/table/T2
Four of the papers most commonly used by
antifluoridationists and the assessment of the
methodological quality of each paper
http://healthevidence.ca/downloads/Fluoridation_Evidence,_summarized_by_Health_Evide
nce_16.Dec.11.pdf

21. What Else Can Be Done?
Develop additional strategies to decrease the number of children with tooth decay
i.e.
• Earlier 1st visit to the dental office
• Increase the number of fluoride mouthrinse programs and fluoride varnish
clinics in communities assessed at high risk for decay
• Implement programs that provide early oral hygiene skill development in
communities at high risk to decay. (e.g. toothbrushing programs)
• Finding a solution for those vulnerable individuals that have access or barriers
to treatment
• Support the consideration for a Provincial Dental Health Officer, who can
communicate and coordinate with the appropriate authorities regarding
Regional, Provincial and National oral health needs and goals

22. Saskatchewan Ministry of Health Website Info on Fluoride
http://www.health.gov.sk.ca/community-water-fluoridation

23. References:
CDA Position on Use of Fluorides in Caries Prevention (Revised
April/2010)
Findings and Recommendations of the Fluoride Expert Panel
(Jan/2007)
MHOCOS Letter of Approval of Fluoride Guidelines (Feb/2001)
Fluoride in Drinking Water – Prepared by the Federal Provincial
Territorial Committee on Drinking Water – Heath Canada
A Review of Water Fluoridation – Dr. Steven K Patterson
Attitudes of Canadians Towards Water Fluoridation (Quinonez C.
Locker D. Public opinions on community water fluoridation. Can J
Public Health. 2009 Mar-Apr; 100(2):96-100.)

24. *
Saskatchewan Ministry of Health’s Position Statement
on Community Water Fluoridation
http://www.health.gov.sk.ca/Default.aspx?DN=2b8566d8-567e-4276-8b216c6cf3f87639
Additional Position Statements on Fluoride
http://oralhealthalberta.ca/wp-content/uploads/2011/11/WF-PositionStatements.pdf
Public Health - A Return on Investment video clip
http://www.youtube.com/watch?v=TVZxtuZhN_M

25. When public action undermines public health: a critical examination of antifluoridationist literature Jason M
Armfield
http://www.anzhealthpolicy.com/content/4/1/25
Four of the papers most commonly used by antifluoridationists and the assessment of the methodological
quality of each paper
http://healthevidence.ca/downloads/Fluoridation_Evidence,_summarized_by_Health_Evide
nce_16.Dec.11.pdf
Suggested responses to antifluoridationist arguments
http://www.anzhealthpolicy.com/content/4/1/25/table/T2
Saskatchewan Ministry of Health Website info on Fluoride
http://www.health.gov.sk.ca/community-water-fluoridation