Juliet Guichon notes that public health specialists, rather than unqualified opponents, are the experts when it comes to the safety and benefits of water fluoridation.
Vaccination and fluoridation are public health measures that prevent infectious disease and ultimately save lives. Whereas people increasingly understand that vaccine opposers do harm, many people are only beginning to appreciate that fluoridation opposers also engage in similar, harmful activity.
Because of false and misleading statements (including those made on this site in 2015 by a second-year psychology student), people can be misled about fluoridation safety and efficacy. People who value public health, should take every opportunity to correct such misunderstandings.
They might start by challenging the credentials of people who claim that the decisions of public health experts are flawed. For example, a teacher’s aide in Cape Breton, claims to have sufficient knowledge to override the recommendations of the Public Health Agency of Canada, The Canadian Dental Association, The Canadian Medical Association, The Canadian Public Health Association, the Nova Scotia Public Health Service, among similar organizations in Western nations.
A second-year psychology student and a teacher’s aide should not assume that they know more than medical specialists in Public Health and Preventive Medicine who have completed five years of post-medical-school training to understand, to interpret, and to situate in context health science articles related to public health.
Sometimes, people don’t know what they don’t know: that they are not qualified to provide public health recommendations because they have not done the hard work to graduate from medical school and to complete successfully five years of subsequent training.
Such lack of training might explain the psychology undergraduate student’s claim that “moderate amounts of ingested fluoride are known to cause staining and pitting in teeth, leading to irreversible enamel damage.” This is the sort of anti-public health claim that is wrong at many levels. First, “moderate” is not defined. Second, minerals and compounds that we need, such as salt, can be harmful at high levels but are essential at recommended levels. Third, the claim implausibly suggests that public health experts would recommend a fluoride level in drinking water that would harm the population. Fluoridation at below 2 ppm has never been shown to cause severe fluorosis.
The psychology student goes on to say,
Many advocacy sites in support of banning water fluoridation report correlations found between fluoride and countless other diseases and disorders […]. Although the majority of these disorders promoted by advocacy sites have not been proven causational, there is, I think, reason for some level of public concern.
In other words, her claim is: ‘We should be concerned about matters that have no evidentiary foundation’.
But it is not surprising that people can become unjustifiably concerned. Anti-public health websites use just enough scientific language to confuse and alarm those with low health literacy. The average person does not appreciate that the studies upon which opponents rely are often of no relevance to fluoridation in Canada and the United States because they use dubious methodology, or they were conducted in India, China, or Mexico where there is background environmental degradation or high naturally occurring levels of fluoridation.
One might ask why people with anti-public health views do not amend their false claims when they are shown, over and over again, to be incorrect? The answer is that they are not scientists. Scientists learn from evidence that their hypothesis is incorrect. Ideologues do not. Ideology is impervious to reasoned, evidence-base refutation.
Fluoride is a mineral that naturally occurs in most community drinking water. Nature thought of it first. When adjusted to 0.7 parts per million, fluoride is at a therapeutic level that helps children build strong teeth and helps prevent, reduce, and even reverse tooth decay for all members of the public. Community water fluoridation has been studied thoroughly as a public health measure since 1945 and has been found to be safe and effective at the recommended levels.
Therefore, public health experts across Canada have advised the public about fluoridation and encouraged its adoption. One can find such expert advice from coast to coast in British Columbia, Alberta, Saskatchewan, Manitoba, Ontario, Quebec, New Brunswick, Nova Scotia, Prince Edward Island and Newfoundland and Labrador.
Conspiracy theorists have propagated false and misleading information that has caused fluoridation cessation in some cities. Studies of decay rates before and after fluoridation cessation have shown, in Calgary, Windsor and Juneau, Alaska, that dental decay significantly increases when fluoridation ceases.
We should understand and appreciate that there is significant expertise among public health experts who continually monitor water quality and review every study as it appears, constantly examining the safety and efficacy of fluoridation.
To use a sports analogy, medical specialists in Public Health and Preventive Medicine are in your locker room because they have your back on public health issues. And as Toronto Raptors basketball champion, Kawhi Leonard says, “If they are not in your locker room, then don’t listen to them.”
Juliet Guichon is an Associate Professor in the Cumming School of Medicine, University of Calgary. @JulietGuichon