Letter to the Editor of the Toronto Star regarding its weekend story regarding the US Department of Health and Human Services (HHS) finalizing its decision to set 0.7mg/L as ideal for community water fluoridation.

RE: Rethinking fluoride after 70 years (May 2, 2015; page WD8)  In the World Section of Saturday’s paper, the Toronto Star ran a piece from the Associated Press regarding the recent US recommendation on the fluoride level for communal water systems. Thank you for highlighting this announcement which now aligns the fluoridation level in American communities with Canadian ones. The U.S. Department of Health and Human Services (HHS) first put forth the recommendation four years ago, and it was finalized on April 27, 2015. In 2011, Health Canada recommended 0.7 mg/L as the appropriate level of fluoride in drinking water for preventing tooth decay.  In Ontario communities where fluoride is added, the levels have been set between 0.5-0.8 mg/L since 2008. The updated HHS recommended fluoride level reflects two key facts:

• First, Americans today have access to more sources of fluoride — such as fluoride toothpaste and mouth rinse — than they had in the 1960s, when the previous recommendation was made.
• Second, research shows that the average amount of water consumed by children is fairly consistent across all U.S. regions, regardless of the local climate. In the 1960s, scientists believed that water consumption habits varied in different regions, possibly because air conditioning was less common than it is today. The newer data on water consumption means a single fluoride level — instead of a range, is appropriate.

 Health officials continuously review research and rely on the best science to consider whether standards like this need to be updated. This is not unique to fluoride. Several years ago, for example, health experts updated recommendations for the daily consumption of Vitamin D and calcium. Your story implied that the reason for the change was that “40% of adolescents have tooth streaking or spottiness caused by excessive fluoride”.  Other media outlets have said similar. However, to give your readers context, this tooth streaking or spottiness, also called dental fluorosis, is mild and barely visible – i.e. you don’t see it. And the most important thing you won’t see in many of these same adolescents is tooth decay. Research continues to prove that fluoridation at these levels is safe, effective and equitable. It is also very cost-effective, saving folks money down the road by avoiding treatment for the pain and infection of tooth decay.  Paul SharmaPresident, Ontario Association of Public Health Dentistry