In 2011, the Calgary city council decided to remove fluoride from Calgary’s water supply. As is only to be expected, that decision has had some effects, so let’s talk about what fluoride is, how it affects teeth, and how oral health has changed since this decision was made.

Fluoride is a naturally occurring anion of fluorine. Basically, fluorine gas is one of the elements on the periodic table. However, it is incredibly reactive, so it prefers to react with other elements in order to create more stable compounds. In today’s world, “reactive” is kind of a buzz word for dangerous, but this is actually a normal and safe process. Take for example chlorine gas — an element closely related to fluorine. As a gas, chlorine was used as a cruel weapon during the first world war, but the most common form of chlorine is actually sodium chloride, better known as table salt. Like our normal table salt, fluoride (a salt form of fluorine), is found all over our natural environment. It’s in the soil, the air, and even water. In fact, the Bow River and Elbow River both naturally have some fluoride. On average, the naturally occurring fluoride concentration of these rivers is between 0.1 and 0.4 mg/ L of water.

So now that we understand that fluoride is a completely natural part of the environment that we drink anyways, why is everyone making such a big fuss about whether or not Calgary adds a little extra (between 0.3 to 0.6 mg/L) fluoride to the city water supply?

Those in favour of fluoride understand it’s important role in tooth care. Fluoride is one of the few tools that people have for remineralizing softened enamel — the strongest mineral your body can create. Unfortunately, when enamel is exposed to acid (created by the bacteria in your mouth as they eat sugars from your food), the chemical structure of the enamel changes. This causes it to weaken and leaves your teeth vulnerable to the bacteria and to decay. Fluoride allows the enamel to absorb calcium and phosphate in order to remineralize back into the strong form. However, you need to meet a basic minimum concentration of fluoride for this process to work, around 0.7 mg/L.

Those against fluoride in water argue it can cause fluorosis. When young children (under 8) are exposed to too much fluoride, it can cause aesthetic concerns like little flecks on their adult teeth to more severe damage. Those against fluorination believe that the city may not regulate fluoride carefully enough and that could cause ill intended consequences. They also disagree with the idea of adding a medical treatment to the water supply for everyone without technically getting consent from each individual person living in the city. These concerns are not invalid.

However, the concentration of fluoride necessary to cause damage to teeth can occur naturally in rivers and springs. In fact, children drinking bottled water can just as easily develop fluorosis as those drinking fluoridated city water, since that bottled water may be sourced from water with naturally occurring high fluoride. It’s also worth noting that while fluoridated city water has caused fluorosis in some cities, the fluorosis in these cases are benign white flecks that do not affect the integrity of the tooth. Finally, since fluorine was voted out of Calgary’s water by the council in 2011, the severity of decay found in Calgary children has worsened. While fluorosis is a valid potential concern from adding fluoride, increased tooth decay in Calgary children, especially the children from poor families, is an actual problem that is negatively affecting kids and their families right now because of the decision.

Like most issues involving public health, whether to include fluoride in drinking water or not is a complicated topic. We hope that this blog has helped to give you some insight into what both sides of the debate are thinking, and that you’ll be able to make an informed decision about any actions you take for or against fluoride in the future.