Experts call for fluoridated water in Kingston, despite objectors

We all use running water daily and for everyday things, but local health-care experts say that adding fluoride to the water supply in Kingston can benefit everyone who uses the water the same way: by fighting tooth decay. Photo by Mart Productions.

Three medical experts advocated vigorously to Kingston City Council that adding fluoride to the City’s drinking water would help end the suffering of children, but a few in the room didn’t think that was enough evidence.

At Council’s regular meeting on Tuesday, May 7, 2024, Councillor Conny Glenn introduced a motion asking that City staff present information on the feasibility of fluoridating drinking water at a Special Meeting to be held no later than the end of 2024. After hearing delegations on the matter, the motion eventually passed, but not without some dubious testimony and questions from non-experts in the room.

The 2019-2022 City of Kingston Strategic Plan included a priority directing staff to examine the feasibility of fluoridating the drinking water. In 2019, City staff conducted research; worked with Kingston, Frontenac, Lennox and Addington (KFL&A) Public Health and Utilities Kingston; and facilitated some engagement on the topic of fluoridation of the drinking water. However, work on this file was halted with the COVID-19 pandemic and was not included in the 2023-2026 City of Kingston Strategic Plan. In the meantime, KFL&A Public Health has continued to identify the lack of fluoride in the drinking water as a major health issue impacting the health of thousands of Kingston residents.

Several delegations at the meeting advocated for fluoridating the drinking supply. All the medical experts in attendance agreed with Health Canada’s recommendation that drinking water have 0.7 mg/L (milligrams per litre) of fluoride for good dental health.

First, Council heard from Dr. Susan Phillips, whose extensive experience as a family physician in Canada’s far north, inner city Toronto, and disadvantaged areas of Kingston has fostered her research interests in how social factors intersect with biology to shape health. As an internationally recognized researcher, she has advised or collaborated with the World Health Organization; the governments of Canada, France, Bosnia, and Serbia; the Swedish Research Council; and universities on four continents. 

Phillips said that health inequity was evident in the mouths of her patients. Having worked in eight remote Indigenous communities where the government provided what she called “a relatively successful fluoride rinse program” in schools, Phillips called this rinse program “a makeshift measure. It was somewhat effective, but only somewhat because it delivered care at an individual level.”

Phillips noted that in Toronto, she observed that fluoride introduced to the drinking supply had all but eradicated tooth decay in just one generation. So she was shocked to learn when she moved to Kingston in 1989 that the City’s public water was not fluoridated. “Just like on those remote reserves, I had to find an individual solution.”

“So after 30 years of practicing in Kingston, I’ve seen numerous patients — young patients in their 20s or 30s — whose teeth are black and crumbling. It’s distressing,” she said. “I’m pleased that the city is considering fluoridating drinking water. There’s extensive evidence that fluoridated water is beneficial [in] protecting teeth from cavities and that the risks are tiny.”

“My specific reason for speaking is to highlight health equity… When fluoride is added to municipal drinking water, poor children benefit exponentially,” Phillips said.

Next, the council heard from Dr. Jennifer Archibald, a local dentist who earned a diploma in pediatric dentistry from Harvard School of Dental Medicine and Boston Children’s Hospital. She also shared her belief that Kingston’s water needs fluoridation. As a pediatric dentist, Archibald has previously worked in Toronto, Detroit, Michigan, Boston, and London, Ontario. “[Kingston] is the only city with no fluoride in the water. And I’m finding that the rates of cavities here are the highest among any of the children or adults that I have treated.”

“Tooth decay,” she said, “is the most common childhood disease… It’s four times more common than asthma and five times more common than obesity. It also is largely preventable with good oral hygiene practices, access to healthy foods, but also fluoride.”

Archibald shared photos of her patients (with their parents’ permission) to illustrate the importance of water fluoridation and minimizing tooth decay in the community’s children.

Several photos showed devastating tooth decay that affected her young patients’ abilities to chew and speak. One patient was treated under general anesthesia and actually had to have four front teeth removed, Archibald said. “Imagine you’re a three-year-old and you don’t have your front teeth. How can you talk and develop speech and social skills in school?”

Archibald explained that many of the children were from low-income homes. “We’re one of the few offices that sees these children, and our wait list is almost six months. Not only that, but untreated decay can lead to pain and infection. So a lot of these children come to our office, waiting months in pain and agony, and they can’t eat. And they sometimes even develop facial swellings. They have to be on long courses of antibiotics… Imagine if that was you or your child: the agony, the sleepless nights. It’s heartbreaking.”

“These are pictures of what I see daily,” she reiterated. Many of the children she treats under general anesthesia. “So imagine you’re a parent, and your child has to have a nasal tube to breathe on the operating room table. It’s sad to me [that] their cavities are so big that we aren’t able to do treatment on them awake.”

She has other patients, she pointed out, “who have developed severe facial swelling, and they have to be admitted to the hospital on IV antibiotics. So their parents or their families miss out on work. They’re there for days, they miss out on school, and it’s taking a toll on our hospital system.”

“Children in Kingston are suffering, and there’s something we can do about it, something small. I urge Council to continue the discussion on community water fluoridation,” she concluded.

Councillor Gary Oosterhof directed a question and concern to Dr. Archibald: “Why wouldn’t we establish other programs instead of mass medication… because fluoride is a toxic substance, right? In the rural area I represent, fluoride is naturally present in the well water. So the concern I have is, why would we not look at other programs that could accomplish that?” 

Archibald answered directly, “First of all, fluoride isn’t toxic at the levels that it would be introduced into the water… 0.7 parts per million or less, which has been shown to be very safe in adults and children. There have been minimal negative consequences in the research, and the evidence for any negative effects is not well supported. Over 70 years of research has been conducted on its safety and efficacy in treating tooth decay. And I think, to that point, it is one of the most cost-effective measures.”

“It is one of North America’s top 10 greatest public health achievements in the 20th century because it has been shown to make a difference in the lives of people who might not have access to pharmaceuticals or to go to a dentist or wait six months,” she went on. “As Dr. Phillips said, it helps improve health inequities.”

Another delegation by Marion Gilmore was added to the agenda through a motion from Oosterhof. Gilmore did not state her credentials, but spoke against fluoridation. She talked from notes that she said detailed the history of fluoride, which presented a far different story from those of the experts in the room.

However, what she presented was quite literally a theory that a conspiracy exists between the “medical mafia,” the United States government, and the “military industrial complex” to dispose of “a hazardous waste byproduct from aluminum, fertilizer, and the nuclear industries… Rather than paying to dispose of their hazardous waste, these companies can sell their waste to municipalities so they can drip it into our water and forcibly ‘mass medicate’ the entire population.”

However, after a brief online search, it is apparent that she was reading word for word an article written in 2015 by American misinformation marketer Ty Bollinger. Bollinger has no medical training and has a history of disseminating misinformation on social media about cancer treatments, anti-vaccine conspiracy theories, ineffective or unproven cures, and other conspiracy theories. With his wife Charlene, he runs the website “The Truth About Cancer” and its associated social media accounts, where they sell books, videos, and nutritional supplements based on their ideas.

Next came a briefing from Dr. Piotr Oglaza, KFL&A Public Health’s Medical Officer of Health, who detailed the benefits of water fluoridation at the safe level of 0.7 mg/L.

“As Medical Officer of Health, it is my responsibility to do everything to improve oral health and overall health,” Oglaza emphasized. “We know that about 20 per cent of Canadian adults have untreated tooth decay. That’s over 20,000 adults in Kingston who might be suffering. For these folks, their ability to eat, sleep, focus, and attend work can be substantially impacted.”

“In our school children, the problem is getting worse… You may have heard some of these statistics in the news recently. The proportion of five-year-olds who have experienced tooth decay has increased from 25 to 40 per cent. Of school-age children… each child with decay has an average of four affected teeth, and these children are suffering. The increase in our region has been greater than [in] the neighbouring regions of Hastings-Prince Edward and Leeds-Grenville-Lanark. This trend has continued in our jurisdiction through this current school year.”

Oglaza explained that fluoridation is one immensely easy and safe way to combat what is “largely a preventable disease… for everyone in our region.”

Dr. Piotr Oglaza presents a health impact pyramid in an attempt to explain to council that fluoridation works and has negligible harmful effects. Community water fluoridation is at the base of the pyramid because, as he explained, “it has the largest impact on the whole population and requires the least individual effort.” Screen captured image.

“No single intervention can do it all,” he acknowledged, pointing to a graph of a health impact pyramid that illustrates layers of protection. “Just like many other complex public health issues, tooth decay isn’t prevented by one single approach.” As such, KFL&A Public promotes several layers of prevention.

The top point of the pyramid highlights healthy individual behaviours such as brushing with fluoride toothpaste and eating healthy foods. However, Oglaza said, “while these individual behaviours are very important, promoting these healthy behaviours has the lowest impact on the whole population.”

“We also support people’s access to dental care,” he explained, pointing to the middle level on the pyramid. KFL&A Public Health connects individuals with dental health treatment programs that are available for children, adults, and seniors because, he noted, “going to the dentist and paying for dental care can be difficult for many; not everyone can qualify for these programs.”

Community water fluoridation is at the base of the health impact pyramid, he said, because “water fluoridation is the most cost-effective way to reduce tooth decay [and] it has the largest impact on the whole population and requires the least individual effort.”

Oglaza made it clear again that fluoride also exists naturally in the water supply. “In Kingston, the fluoride level in water is less than 0.1 parts per million, and that’s the water naturally occurring in Lake Ontario. We’re talking here about adding a small amount of fluoride to protect teeth from decay… and that optimal level of dental health in water is 0.7 parts per million.”

He emphasized the minimality of this amount by pointing out that “black tea can have a fluoride level as high as six parts per million,” and people drink it every day.

Adjusting fluoride levels in water is similar to fortifying foods, Oglaza went on. “We add vitamin D and A to milk and folic acid to flour to keep everyone’s bodies healthy.” He said the maximum “acceptable concentration” for fluoride in drinking water as set by Health Canada is currently 1.5 parts per million, more than twice the amount he is advocating for.

“Everyone can benefit from this, even the most underprivileged. This is especially critical for those who might not be able to get to the dentist [or] maintain healthy individual habits for healthy teeth. I support community water fluoridation, but I’m not alone in this position… Over 100 provincial, national, and international health, medical, and dental organizations endorse community water fluoridation as a safe and effective way to prevent tooth decay.”

Medical Officer of Health Dr. Piotr Oglaza presented this graphic of the weight of evidence and endorsement for fluoridation, and he noted that no respected health organizations oppose fluoridation. Screen captured image.

“So how do we know that [fluoridation] is effective and safe? We need to look at the entire body of evidence to tell that. Health Canada and other experts make recommendations based on that entire body of evidence and research on the topic. If we make public health decisions based on one research study, one single research study that might be flawed in terms of study design, or a small group of selected studies without including other sources of evidence, this can lead to poor decisions and misinformation.”

Councillor Jimmy Hassan asked Oglaza how he would “counter the information [that] came in with another delegation before you from Marion [Gilmore] … information from the history of how it was used and what was the reason for using fluoride.”

Oglaza reiterated that facts matter: “I do not have information to comment on that… I can speak to the body of evidence in terms of the safety and efficacy of fluoride, which again mentions 75 years of research by reputable medical and dental organizations. So that’s the part I can speak to.”

When it came time to debate the motion, Mayor Bryan Paterson reminded councillors on more than one occasion that the motion was simply to ask staff to compile more information and have a meeting on the subject in the future, not to decide right that moment whether the water should be fluoridated.

Councillor Gary Oosterhof (centre) acknowledged his “lack of medical training” but said that although he disagreed with them, he was “not disrespecting the experts” in the room. Screen captured image.

Oosterhof stated that he would represent the 18 per cent of Kingstonians who don’t support fluoridation, according to a survey conducted by Public Health, and he referred to a case going through American courts that might prove he was correct in doing so. “Fluoride is being added to water even if some people don’t want it, and still others do not even know about the fluoride being added to the water or the health risks… I believe I would completely differ from our professionals in the room… there’s a very powerful court case in the US right now that is going to be decided any day about whether fluoride should be continued. So that means that really smart people are saying there could be more concerns with fluoride, and I think the Kingston public needs to know that as well.” Oosterhof concluded that despite this, he was “not disrespecting the experts” in the room.

Though Oosterhof did not specify what case he was referring to, it is almost certainly Food & Water Watch, Inc. et al v. Environmental Protection Agency et al, a current landmark California lawsuit in which the plaintiffs petitioned the Environmental Protection Agency (EPA) to regulate the fluoridation of drinking water supplies because, the plaintiffs maintain, the ingestion of high levels of fluoride poses an unreasonable risk of neurotoxic harm to humans. After the EPA denied that petition, the plaintiffs filed the suit seeking judicial review of the EPA determination.

However, it is important to note, as does Bloomberg Law, “The EPA limits the amount of fluoride in drinking water to 4 milligrams per litre of water (mg/L). This enforceable standard reflects the agency’s knowledge that high fluoride levels occur naturally in some parts of the USA. However, [it can be costly for state regulators] to reduce fluoride to the recommended 0.7 mg/L, the concentration the Department of Health and Human Services recommends.”

It is also essential to note the context of this court case: it is about people being exposed to large, unsafe amounts of fluoride due to ineffective system management, not about adding safe amounts to water that contains a negligible amount, like in Kingston.

Further, Oosterhof stated that the “U.S. Surgeon General is no longer establishing a strong position for fluoride. That’s true. So that means [anti-fluoridation advocates] must have science to support them.”

The mission of the United States Surgeon General — just like that of the local Medical Officer of Health — is to give the public the best scientific information available on improving health and lowering the risk of illness and injury. Current Surgeon General Vivek H. Murthy’s latest document on the subject, Oral Health in America: A Report of the Surgeon General, notes that community water fluoridation continues to be the most cost-effective, equitable, and safe means to provide protection from tooth decay in a community.

Councillor Glenn had clearly heard enough when she cautioned against “throwing around facts and science” without proper evaluation. “It is important that we understand that there’s good science and bad science, that there are what people call facts that are opinions.”

The motion carried with only Oosterhof opposed.

The agenda from this meeting of Kingston City Council can be found on the City of Kingston’s council meetings webpage, and the meeting can be viewed in its entirety on the Kingston City Council YouTube channel.

Council meets on the first and third Tuesday of each month (except in July and August, when it meets once each month) at 7 p.m. in Council Chambers at Kingston City Hall, 216 Ontario Street.

5 thoughts on “Experts call for fluoridated water in Kingston, despite objectors

  • Ah, yes, crazy people against established science! But these crazy people are making money from their crazy off the backs of other crazy people! Do we owe them a living?

    I, too, couldn’t believe that Kingston did not have fluoridated water, when I moved here 12 years ago.
    In a city with one of the best Med schools in the country and this discussion goes on.

    Ridiculous!

  • Thank you for investigating the claims against fluoridation. Presenting both sides is admirable but more admirable is your research into the claims made by the anti- fluoride people. Conspiracy theories, as you point out, aren’t facts and are detrimental to our health!

  • Absolute kudos to the work that went into this article, clearly debunking conspiracy, nonsense. You guys are really on your game!

    • I second these comments. Kudos to the staff for their in depth reporting on this and other matters in Kingston and area.

  • Thank you for this measured and balanced presentation of the debate in council, combined with background information that illuminates the information presented to council.

    It is much easier to understand the debate in the US knowing that it in part involves allowing very high levels of naturally occurring fluoride to be ingested, as opposed to adding low levels to be added to municipal water.

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