1. Community Water Fluoridation Community Water Fluoridation Maintaining a Legacy of Healthy Teeth in Muskoka Lakes Dr. Charles Gardner, Medical Officer of Health, To the Muskoka Lakes Township Council September 16, 2016

2. Muskoka Lakes Council’s Decision To consider the recommendation from the Committee of the Whole to discontinue community water fluoridation (CWF) Under the Fluoridation Act, it is municipal councils that decide on CWF CWF is a challenging public health topic Muskoka Lakes Council has historically supported CWF, as a safe and cost-effective way to protect the oral health of its citizens

3. Fluoridation: A Public Health Priority Our recommendations to new Municipal Councils in 2014 included:  Commence community water fluoridation to improve oral health for all, particularly those most vulnerable due to low income and/or social circumstances.  Maintain and support water fluoridation in communities that currently have a fluoridated water system.

4. Tooth decay is an important child health issue Source: Photograph provided with client consent courtesy of Niagara Region Health Department

5. The prevention of tooth decay Fluoridation still makes a contribution Oral hygiene – including fluoridated toothpaste (precaution re excessive quantities and swallowing in young children) Healthy diet – reduced sugar content Dental care – pit and fissure sealants, scaling, fluoride applications Social determinants of health – income, demographics, dental insurance coverage Community water fluoridation

6. What is fluoride and fluoridation? Fluoride is a mineral that naturally occurs in rocks, soil, and water. –Fluoride makes the outer layer of teeth (the enamel) stronger. –Hydrofluorosilicic acid used for CWF. Produced during phosphate fertilizer production – National Sanitation Foundation standards. Fluoridation: adding fluoride to municipal water supply to the concentration range to optimize dental benefits while avoiding adverse effects.

7. The Effectiveness and Safety of CWF: Reviews and Systematic Reviews Water fluoridation for the prevention of dental caries. Cochrane Database of Systematic Reviews 2015, Issue 6. Iheozor-Ejiofor et al Health Effects of Water Fluoridation: An evidence review. Health Research Board (2015). Sutton et al (Ireland) Health effects of water fluoridation: A review of the scientific evidence. The Royal Society of New Zealand TA. (2014) Water fluoridation: Health monitoring report for England 2014. Public Health England, Department of Health: London. Preventing Dental Caries: Community Water Fluoridation, 2013. The Guide to Community Preventive Services: The Community Guide, (US) Effectiveness of water fluoridation in caries prevention. Community Dent Oral Epidemiol 2012; 40 (Suppl. 2): 55–64. Rugg-Gunn AJ and Do L. Guidelines for Canadian Drinking Water Quality: Guideline Technical Document – Fluoride, December 2010 Health Canada,

8. Safety of community water fluoridation Systematic reviews of over 3,000 published studies – up to 2015 No evidence that CWF has any detrimental effects on: –bone fractures, hip fractures, bone characteristics –IQ, neurological conditions, Alzheimer’s, autism, ADHD –cancers, osteosarcoma –cardiovascular disease –kidney disease –endocrine disorders

9. CWF: A Health Advantage in Muskoka However, since 2013 this has been in decline: –District of Muskoka, Huntsville and Lake of Bays discontinued CWF –However Gravenhurst, Bracebridge, Georgian Bay, and Muskoka Lakes councils have continued CWF

10. Public Support for CWF in Muskoka

11. Muskoka Lakes Council’s Decision Muskoka Lakes Council has historically supported CWF, as a cost-effective way to protect the oral health of its citizens As your Medical Officer of Health I urge Council to continue CWF. Otherwise, past experience strongly predicts that your community members will experience: –Increased avoidable dental decay for children and probably for adults whose primary water source is one of your municipal water systems –This increase will be greatest among children from families of low income