Drinking water fluoridation

Fluoride makes the teeth more resistant to decay.

Water fluoridation continues to be supported by more than 90 national and international professional health organizations.

What is fluoride?

Fluoride is a naturally occurring mineral that is found in soil, air, and water.

Why is fluoride added to drinking water (fluoridation)?

Fluoride is added to drinking water to protect against tooth decay. Putting fluoride in municipal drinking water means that everyone in the community can benefit from the protection, regardless of factors such as income, age, residence, or education.

Are there other sources of fluoride?

Teeth can also be protected by fluoride from other sources. Fluoride can be purchased in the form of toothpastes, rinses, chewable tablets, or drops, and through the services of a dental professional. These sources of fluoride require resources such as money, insurance, and knowledge. Not every one has access to these resources, meaning that many people cannot benefit from these sources of fluoride.

Is water fluoridation safe?

Systematic reviews have examined the safety of water fluoridation. The most recent Canadian reviews were conducted by Health Canada in 2007 and 2010. These reviews concluded that there is no health risk from the fluoridation of community drinking water at current levels and that fluoridation continues to be an effective public health strategy to prevent dental disease. Fluoride levels in drinking water are regulated in Ontario under the Safe Drinking Water Act. The Health Unit works closely with the City of Greater Sudbury to monitor fluoride levels in municipal drinking water and ensure compliance with the Act.

Who supports water fluoridation?

Locally, the Sudbury & District Board of Health and its provincial association, the Association of Local Public Health Agencies (alPHa), support water fluoridation. The Board of Health recognizes that water fluoridation is the most cost-effective strategy to prevent dental decay and to ensure that all citizens receive the benefits of reduced dental decay. The Board further recognizes that dental decay is not a benign disease (it is not harmless)—it causes physical pain. If untreated, it can result in social exclusion and shame. Treating dental decay can be very costly and cause significant financial hardship.

Water fluoridation continues to be supported by more than 90 national and international professional health organizations including the World Health Organization, Health Canada, Canadian Dental Association, Ontario Medical Association, Canadian Public Health Association, and the Association of Local Public Health Agencies.

Who benefits from water fluoridation?

Studies of municipal water fluoridation have demonstrated that fluoridated municipal water supplies are associated with reduced rates of tooth decay.

Tooth decay is the single most common chronic childhood disease. Based on scientific research, fluoridated drinking water greatly reduces the number of cavities in children’s teeth, which contributes to their healthy development. Water fluoridation is a population health strategy for all residents. This means that it is an effective prevention strategy that reaches every one—this is especially significant for marginalized populations of all ages (preschool to elderly) who may not have the means or knowledge to seek fluoride treatments.

What is the history of water fluoridation in the City of Greater Sudbury?

The municipal water supply for the City of Sudbury has been fluoridated since 1952. The remaining municipalities of the current City of Greater Sudbury began fluoridating between 1978 and 1993.

Doesn’t the Health Unit provide fluoride treatment already?

The Health Unit is mandated and funded to screen elementary aged children for dental decay. Preventive dental care, including fluoride treatment, is offered to eligible children identified through this screening. Children are eligible for fluoride treatment through the Health Unit if they have decay or are at risk for decay. They are also eligible if they are from a family with low income or have a sibling with decay or poor oral hygiene. Children are not eligible for public health fluoride treatments if they have access to insurance or dental coverage through another program such as Ontario Works.

The Health Unit only offers this preventive dental program to children. And, even among this age group, only about 1% of children receive treatment. Fluoridated water reaches all children as well as people from all age and socioeconomic groups.

Doesn’t everyone have insurance to cover dental costs?

Surveys by the Health Unit show that about 75% of area residents have access to dental insurance. Even those with dental insurance benefit from the preventive effects of water fluoridation. For the quarter (25%) of the population without dental insurance, water fluoridation is a key defence against dental disease, which is painful and stigmatizes those who suffer from it.

What does the data say?

In the Sudbury and district area, almost 80% of households reported drinking tap water (27% reported a combination of tap and bottled water). The majority of area households reported that they were in support of adding fluoride to drinking water, with only 17% opposed.

A recent Canadian survey highlighted the worse dental health of Canadians with lower income: lower income families had oral health outcomes almost two times worse than families with higher income. Preventive dental health strategies must not rely on a person’s ability to pay if they are to be effective for this more vulnerable population. Water fluoridation is a strategy that benefits everyone.

What are the financial costs?

Water fluoridation is the most economical method to reduce the burden of dental disease in the population. The cost of community water fluoridation varies in each community depending on a number of factors, which include the size of the community, number of fluoride injection points, amount and type of equipment used, its price and cost for transportation and storage and expertise of personnel at the water plant. It can be estimated from current cost analyses data that the annual cost to fluoridate a Canadian community ranges from approximately $0.77 to $4 per person per year.

Water fluoridation is the most cost-effective method of preventing tooth decay. School-based dental prevention activities, professionally applied topical fluorides and dental health education are not as cost-effective in preventing dental decay as water fluoridation. The City of Hamilton conducted an analysis of the cost of delivering fluoride through four different methods. The annual costs of alternate fluoride delivery approaches in 2008 are presented in the table below.

Preventive MeasureAnnual Cost per Person
Topical fluoride applied two times per year to all high risk individuals by private dentists$96.12
Topical fluoride applied two times per year to all high risk individuals by public health services$44.50
Distribution of tooth pastes and tooth brushes to all members of the population$8.50
Water fluoridation$0.71 to $0.86

The cost of treating tooth decay is significantly higher than the cost of preventing it. The cost of adding fluoride to municipal drinking water is minimal when compared to the large costs of restorative dental surgery for children living without fluoridation. The average lifetime cost per person to fluoridate a water system is less than the cost of one dental filling. According to the US Centers for Disease Control and Prevention, for every $1 invested to fluoridate community water supplies, there is an estimated $38 in avoided costs for dental treatment.

The economic importance of fluoridation is emphasized by the fact that the cost of treating dental decay is paid not only by the individual, but also by the general public, through health insurance premiums, health departments and community health clinics. With the escalating costs for health care, fluoridation remains a preventive measure that benefits all members of the community, regardless of socioeconomic status, at a minimal cost.

Core messages

Fluoride is a mineral that exists naturally in virtually all water supplies, even the ocean. Usually, however, the amount of fluoride is too low to prevent tooth decay. This is why many communities in Canada add a small amount to reach the level proven to protect teeth.
The leading health experts endorse community water fluoridation as a safe, effective way to reduce cavities. These experts include the Canadian Dental Association, the Canadian Pediatric Society, Health Canada, the Centers for Disease Control and Prevention, and the World Health Organization.
Using fluoride toothpaste is important, but it doesn’t give maximum protection against cavities. Drinking fluoridated water provides crucial added protection against tooth decay, and many studies prove it.
Canada is one of the birthplaces of community water fluoridation. Our dental and medical officials from the 1940s were pioneers who helped conduct the initial research proving that fluoridation significantly reduces cavities. Many other countries have since followed our lead.
Canada has a tradition of fortifying foods and beverages with vitamins and minerals to protect human health. For example, Vitamin D is added to milk, and folic acid is added to bread and pasta. Adding fluoride to water is one more way we help keep children and adults healthy.
Fluoridation’s positive impact is supported by hundreds of studies and nearly 70 years of experience. Some of these studies have been conducted within the past few years.

This concise core messaging was written by Matt Jacob of the Children’s Dental Health Project, and was reproduced with permission.

Supporting documents

This item was last modified on March 27, 2018