Calgary city council after a 13-2 vote in 2021 passed a decision to add fluoride to drinking water, with the much-delayed initiative expected to go into effect in the near future. The city has not determined a set date due to delays in infrastructure. The often heated debate on fluoride stems from the amount of fluoride added to water, and if the process of artificial fluoridation in a public water supply constitutes medication without consent. Various studies have shows community water with artificial fluoride concentration above 0.7 mg/L can be linked to decreased IQ in children, hormone interruption and dental fluorosis and skeletal fluorosis. Health Canada has assessed the optimal level of fluoride in the water is 0.7 mg/L, which is what Alberta Health Services recommends. The Government of Canada refers to the World Health Organization as one of its affiliates, which claims 1.5 mg/L is a safe concentration. .Since Calgary's 2021 vote to move forward on community water fluoridation, the project’s budget has inflated from $10.1 million to $28.1 million — a number projected back in July 2023, and expected to rise. Additional costs however will be found within the existing budget, and the city wouldn’t be asking for more funding, claimed city officials in April. They said the delay from the anticipated June 2024 to the first quarter of the next year was due to “ongoing uncertainty with the global supply chain” and necessary infrastructure upgrades at the Glenmore and Bearspaw water treatment plants.The $28.1 million does not include operation and maintenance costs, which are expected to be roughly $1 million annually, including $864,000 in operation costs and $100,000 to $200,000 for maintenance. A 2021 fluoride plebiscite indicated many residents support the measure. Calgary previously had fluoride added to its water system, but that was discontinued in 2011. The infrastructure that existed back then was deemed to be at the “end of its lifecycle” and removed. Edmonton, Lethbridge, Red Deer and other Alberta municipalities already add fluoride to drinking water. .Fluoride is a naturally occurring mineral found in water, with trace amounts found in soil and food. The mineral is known to strengthen tooth enamel and prevent decay, especially for people who don't have access to dental care or fluoride toothpaste. Some have concerns that people who don’t have access to dental care or fluoride toothpaste or mouth rinse can develop serious tooth decay and infection, especially in children.Yet, a review from the Cochrane Library from August 2023 on water fluoridation for the prevention of dental caries concluded it “could not be sure whether adding fluoride to water reduced tooth decay in children’s permanent teeth or decay on the surfaces of permanent teeth.”The institution noted prior to 1975, when fluoride was less available in toothpaste and oral rinse, fluoride in community water systems indicated an improvement in children’s tooth decay. “We were unsure whether there were any effects on tooth decay when fluoride is removed from a water supply” and “we were unsure if fluoride reduces differences in tooth decay between richer and poorer people,” wrote Cochrane Library..The US Centers for Disease Control and Prevention in contrast says dental decay is reduced 25% in both adults and children “by repeated, low-level exposure to fluoride through the water supply.”The levels the CDC refers to though are between 0.5 and 0.9 mg/L, and the federal body points to a federal review of the science from the National Toxicology Program (NTP) that found harmful effects to children’s IQ when the concentration levels rise to 1.5 mg/L.Professor of medicine at the University of Calgary James A. Dickinson earlier this year said after artificial fluoridation was removed from city water, health issues became apparent. He referred to a 2021 study comparing dental health in Calgary and Edmonton children over seven years, after Calgary stopped fluoridation in 2011, and found “significantly” more cavities in Calgarian children — 64.8% compared to 55.15% in Edmonton. “In just eight years after fluoridation ended in 2011, the need for intravenous antibiotic therapy by children to avoid death by infection rose 700% at the Alberta Children’s Hospital,” Dickinson told CTV in the spring.“Since fluoridation ceased, the cavities in teeth are more numerous and larger. These might require filling or extractions.”However, opponents argue artificial water fluoridation constitutes “medication without consent” and express concern over high levels of fluoride in public water systems. Others argue fluoride is a neurotoxin and is associated with adverse neurological and behavioural effects. The matter goes beyond opinions and activist groups. A federal judge in California recently ruled an “unreasonable risk” associated with adding fluoride to the water, while the NTP has concluded with “moderate confidence” in the association of artificial fluoride and lowered IQ in children. .United States District Judge Edward M. Chen, of the Northern District of California, in a court case filed by Food and Water Watch against the US Environmental Protection Agency (EPA) ruled plaintiffs provided enough evidence to “prove” the “prescribed optimal level of fluoridation at the level of 0.7 mg/L” posed an “unreasonable risk of injury to health or the environment.”Advocacy group Safe Water Calgary has referred to this study in making its case against adding fluoride to the city water supply. Chen ordered the EPA to “initiate rulemaking” accordingly. The ruling specifically examines decreased IQ in children.“The issue before this court is whether the plaintiffs have established by a preponderance of the evidence that the fluoridation of drinking water at levels typical in the United States poses an unreasonable risk of injury to health of the public,” wrote Chen. “For the reasons set forth below, the court so finds.”“Specifically, the court finds that fluoridation of water at 0.7 mg/L — the level presently considered ‘optimal’ in the United States — poses an unreasonable risk of reduced IQ in children.”The judge noted while the finding “does not conclude with certainty that fluoridated water is injurious to public health,” but “there is an unreasonable risk of such injury.”“A risk sufficient to require the EPA to engage with a regulatory response,” wrote Chen. Meanwhile, the NTP concluded, “with moderate confidence, that higher levels of fluoride exposure, such as drinking water containing more than 1.5 mg/L of fluoride, are associated with lower IQ in children.”“There were insufficient data to determine if the low fluoride level of 0.7 mg/L currently recommended for US community water supplies has a negative effect on children’s IQ,” states the report. It added the NTP found no evidence of adverse effects of fluoride on adult cognition. .The NTP report cites studies from Canada, China, India, Iran, Pakistan and Mexico “where some pregnant women, infants and children received total fluoride exposure amounts higher than 1.5 mg/L of fluoride drinking water.”“The US Public Health Service currently recommends 0.7 mg/L, and the World Health Organization (WHO) has set a safe limit for fluoride in drinking water of 1.5 mg/L.Florida Surgeon General Dr. Joe Ladapo says he once supported the issue. In medical school students are taught adding fluoridation to the water was a public health measure, he said at a press conference in November. However, after reviewing research and studies of harms and benefits associated with increased levels of fluoride in water released in the past five or so years, including the NTP report, he was “appalled.” “While there’s no question fluoride is an important mineral and can strengthen teeth, it is also the case that fluoride is a neurotoxin,” said Lapado. “Many studies have found a relationship between fluoride exposure and intelligence. A half a standard deviation in drop of IQ in areas with higher levels of fluoridation, a profound effect on health.”“Neuropsychiatric risks have been raised, including ADHD, problems with executive function and decision making.”He cited Canadian studies that found pregnant women and children “exposed to higher levels of fluoride have experienced adverse neurological and neuropsychological effects.” “It is public malpractice, with the information we have now, to continue adding fluoride to water.”.The US National Institutes of Health found “clear IQ reductions were observed at water-fluoride concentrations of about 1 mg/L and above” among all age groups. As for the Government of Canada, officials recognize “several studies have raised concern regarding the potential neurocognitive effects of fluoride at community exposure levels, but questions remain regarding whether the weight of evidence supports a causal relationship.”Health Canada lists dental fluorosis and skeletal fluorosis as suspect outcomes of fluoridation, even at “lower exposure levels” — an assertion the American Cancer Society agrees with. “That possibility should not be ignored,” writes Health Canada, conceding “the science concerning neurocognitive effects and fluoride is rapidly evolving, and consideration should be given to new studies as they become available.”Calgary resident Art Matsui speaking at a Calgary Public Hearing on November 18 said though a plebiscite resulted in a green light on water fluoridation, it’s “no longer a plebiscite” if the substance has been deemed harmful — “it becomes a question of public health.” “For the city to go ahead and do this now, they’re opening themselves up for a huge liability,” said Matsui. Cllr. Dan McLean replied he tends to agree with Matsui’s assertion. “I have my own concerns as well,” he said, adding the matter would likely have to go through “court systems” and “legal challenges.” “I agree, instead of forcing it upon people, it should be a choice.”
