FLUORIDE
What is fluoride?
Fluoride is a naturally occurring mineral found in soil, air and water supplies. Fluoride has a positive effect
on oral health by making teeth more resistant to decay. Fluoride can prevent or even reverse tooth decay
that has started.
Where do I get the fluoride that prevents tooth decay?
For many Canadians, fluoride is added to municipal drinking water supplies, which provides protection to
the entire community. Fluoride toothpastes and rinses can be purchased, and your dentist can provide
professional fluoride products such as gels and varnish.
What is water fluoridation?
Water fluoridation is the process of adjusting the level of fluoride in a municipal drinking water supply to
optimize the dental benefits of preventing tooth decay. The fluoridation of drinking water supplies is a wellaccepted measure to protect public health and is strongly supported by scientific evidence. Fluoride has
been added to public drinking water supplies around the world for more than half a century.
What is the benefit of water fluoridation?
Adding fluoride to water is the best way to provide fluoride protection to a large number of people at a low
cost. The big advantage of water fluoridation is that it benefits all residents in a community, regardless of
age, socioeconomic status, education, employment or dental insurance status. It promotes equality
amongst all segments of the population, particularly the vulnerable population and who may not be able to
afford to visit a dentist.
Another benefit of water fluoridation is the reduction of dental care expenditures. It is estimated that the
cost of dental care in Canada reached $11.4 billion in 2007, making it the second largest item in the
privately funded health care budget, after drugs. In fact, a US study found that for larger communities of
more than 20,000 people where it costs about 50 cents per person to fluoridate the water, every $1
invested in this preventive measure yields approximately $38 savings in dental treatment costs.
over . . .
For more information
DURHAM REGION HEALTH DEPARTMENT
905-666-6241
1-800-841-2729 or durham.ca
If you require this information in an accessible format, contact 1-800-841-2729.
FLUORIDE
Who supports fluoridation of the drinking water?
The use of fluoride for the prevention of dental cavities is endorsed by over 90 national and international
professional health agencies and organizations including Health Canada, Public Health Agency of
Canada, the Canadian Public Health Association, the Canadian Dental Association, the Canadian Medical
Association, the Ontario Medical Association, the US Food and Drug Administration and the World Health
Organization.
In May 2010, Ontario’s Chief Medical Officer of Health, Dr. Arlene King, supported drinking water
fluoridation in Ontario. In February 2011, the Council of Ontario Medical Officers of Health, a section of
the Association of Local Public Health Agencies (alPHa) passed a similar fluoridation resolution. As an
alPHa member, the Region of Durham supports fluoridation of drinking water.
How much fluoride is acceptable in drinking water?
The Ontario Ministry of the Environment (MOE) has established a Maximum Acceptable Concentration
(MAC) of fluoride in drinking water at 1.5 mg/L (Safe Drinking Water Act, 2002, Ontario Drinking Water
Standards).
In Durham Region, fluoride is added to the drinking water supplying six communities:
 Pickering
 Brooklin
 Ajax
 Oshawa
 Whitby
 Courtice
In Durham Region, the concentration of fluoride in the drinking water is maintained at approximately 0.5 to
0.8 mg/L. The Durham Region Health Department is continuously working with the Durham Region Works
Department and the MOE to ensure strict compliance with the accepted drinking water quality standards.
This guarantees that the highest quality water is delivered to Durham Region residents every day.
What is the fluoride product added to the drinking
water?
The Region of Durham uses fluorosilicic acid in its water supply facilities. The Region purchases this
chemical from Solvay Chemicals, Inc. All products used in water purification must meet the standards for
application in potable water. This means that they must meet a number of product quality standards,
including American Water Works Association (AWWA) Standard B703-06 and American National
Standards Institute (ANSI) / National Science Foundation (NSF) Standard 60.
The fluorosilicic acid comes in the form of a liquid solution in tanker trucks. The liquid is added to drinking
water during the final stage of the water treatment process. The average annual cost of fluoridation is
approximately 40 cents per person.
over . . .
For more information
DURHAM REGION HEALTH DEPARTMENT
905-666-6241
1-800-841-2729 or durham.ca
If you require this information in an accessible format, contact 1-800-841-2729.
FLUORIDE
Can exposure to fluoride in drinking water cause other
health effects?
Health Canada continually reviews new scientific reports and articles which explore possible links
between fluoride and various health effects to ensure our advice remains protective of public health.
Currently available published credible scientific literature continues to indicate there are no adverse health
effects from exposure to fluoride in drinking water at the MAC of 1.5 mg/L. Scientific reviews conducted by
a number of international agencies and by Health Canada are in agreement that the weight of evidence
from all currently available studies does not support a link between exposure to fluoride in drinking water
and adverse health effects such as cancer or lower IQ in children.
Is excessive fluoride a health concern?
Drinking water with fluoride levels below the provincial standard MAC of 1.5 mg/L is not a health concern
according to the American and Canadian Dental Associations.
Consuming water with fluoride concentrations between 1.5 and 2.4 mg/L can result in a condition known
as dental fluorosis. Dental fluorosis is a change in the appearance of the tooth, with small white specks
appearing on a child’s front teeth. It only affects the look of the tooth, and doesn’t affect function.
The Canadian Health Measures Survey 2007-2009 found that dental fluorosis is not an issue of concern
for the vast majority of Canadian children (84%). So few children have moderate or severe fluorosis that,
even combined, the prevalence is too low to permit reporting.
Should children use fluoridated toothpaste?
There continues to be debate on whether young children should use fluoridated toothpaste and at what
age should they begin. In general, we recommend:
1. Cleaning of the mouth should begin at birth. We recommend making this part of the baby’s bedtime
routine. The mouth can be cleaned by swiping with a damp cloth after feeding and before bed.
2. It is very important that the baby not receive milk or juice in a bottle when being put to bed. The sugar
in liquids will pool around the teeth and cause decay.
3. When teeth begin to erupt the parent should clean the teeth with a damp cloth or very soft infant sized
toothbrush.
4. At this time toothpaste does not need to be used.
5. We do not recommend fluoridated toothpaste be used until age three years, as children cannot
effectively spit out the excess toothpaste.
6. Parents should help their children brush until the child is at least 6 years old.
7. Always use a soft brush and only use a pea sized amount of fluoridated tooth paste. Make sure the
child rinses with water and spits out any excess tooth paste.
8. Children should begin seeing an oral health professional by 1 year of age and receive professionally
applied topical fluoride as needed, based on the recommendation from their dentist.
over . . .
For more information
DURHAM REGION HEALTH DEPARTMENT
905-666-6241
1-800-841-2729 or durham.ca
If you require this information in an accessible format, contact 1-800-841-2729.
FLUORIDE
Should children receive fluoride supplements?
Fluoride supplements are only required for patients at high risk of developing dental caries, and may be
unnecessary if they are receiving adequate fluoride from other sources such as toothpaste and tap water.
Fluoride supplementation prior to the eruption of the first permanent molars, at 6 years of age, is not
recommended. You should consult your dentist for assessment of your child’s risk of decay before starting
fluoride supplements.
Where can I find more information about fluoride?

Health Canada, It’s Your Health, Fluoride and Human Health
http://www.hc-sc.gc.ca/hl-vs/alt_formats/pacrb-dgapcr/pdf/iyh-vsv/environ/fluor-eng.pdf (Accessed: July 29, 2011)

Canadian Dental Association Position on Use of Fluorides in Caries Prevention
http://www.cda-adc.ca/_files/position_statements/Fluorides-English-2010-06-08.pdf (Accessed: July 29, 2011)

Canadian Dental Association, Fluoride FAQs,
http://cda-adc.ca/en/oral_health/faqs_resources/faqs/fluoride_faqs.asp (Accessed: August 5, 2011)

Canadian Public Health Association, Fighting the Good Fight: Fluoridation of Drinking Water
http://cpha100.ca/12-great-achievements/fighting-good-fight-fluoridation-drinking-water (Accessed: July 29, 2011)

Joint Government of Canada Response to Environmental Petition No. 221 filed under Section 22 of the Auditor
General Act, Petition to Discontinue Water Fluoridation
http://www.fptdwg.ca/English/e-fluoridation.html#responses (Accessed: July 29, 2011)

US Centers for Disease Control and Prevention, Department of Health and Human Services, Cost Savings of
Community Water Fluoridation
http://www.cdc.gov/fluoridation/fact_sheets/cost.htm (Accessed: July 29, 2011)

US Centers for Disease Control and Prevention, Department of Health and Human Services, Community Water
Fluoridation: Questions and Answers
http://www.cdc.gov/fluoridation/fact_sheets/cwf_qa.htm (Accessed: July 29, 2011)

US Centers for Disease Control and Prevention, Department of Health and Human Services, Fact Sheets: Using
Fluoride to Prevent and Control Tooth Decay in the United States
http://www.cdc.gov/fluoridation/fact_sheets/fl_caries.htm (Accessed: July 29, 2011)

European Commission, Scientific Committee on Health and Environmental Risks (SCHER), Critical review of any new
evidence on the hazard profile, health effects, and human exposure to fluoride and the fluoridating agents of drinking
water, 16 May 2011
http://ec.europa.eu/health/scientific_committees/environmental_risks/docs/scher_o_139.pdf (Accessed: July 29, 2011)

Memorandum from Dr. Arlene King, Chief Medical Officer of Health of Ontario, RE: Value of Water Fluoridation, May
31, 2010
http://www.mhp.gov.on.ca/en/healthy-communities/dental/CMOH-on-Fluoridation.pdf (Accessed: July 29, 2011)
over . . .
For more information
DURHAM REGION HEALTH DEPARTMENT
905-666-6241
1-800-841-2729 or durham.ca
If you require this information in an accessible format, contact 1-800-841-2729.
FLUORIDE

News Release, Drinking Water Fluoridation, Statement from Dr. Arlene King, Chief Medical Officer of Health, April 4,
2011
http://www.health.gov.on.ca/en/news/bulletin/2011/docs/hb_20110404_2.pdf (Accessed: July 29, 2011)

Association of Local Public Health Agencies (alPHa), News Release, Public Health Supports Fluoridation, February
17, 2011
http://c.ymcdn.com/sites/www.alphaweb.org/resource/collection/abfad156-5836-4266-85679796140c7f80/alPHa_letter__Support_For_Community_Water_Fluoridation_180211.pdf (Accessed: July 29, 2011)

Safe Drinking Water Act, 2002, Ontario Regulation 169/03, Ontario Drinking Water Quality Standards, http://www.elaws.gov.on.ca (Accessed: August 2, 2011)

Durham Region Health Department, Facts About, Fluoride
http://www.durham.ca/departments/health/facts_about/pdf/fluoride.pdf (Accessed: July 29, 2011)

Durham Region Works Department, Frequently Asked Questions, Water Related Questions
http://www.durham.ca/works.asp?nr=/departments/works/faq.htm&setFooter=/includes/worksFooter.inc#a7
(Accessed: July 29, 2011)

Health Canada, Canadian Health Measures Survey (CHMS), Oral Health Statistics 2007- 2009, Dental Fluorosis,
http://www.hc-sc.gc.ca/hl-vs/pubs/oral-bucco/fact-fiche-oral-bucco-stat-eng.php (Accessed: August 8, 2011)

Solvay Fluorides, Fluorosilicic Acid (Hydrofluorosilicic Acid, HFS), Technical Data Sheet,
http://www.solvaychemicals.us/static/wma/pdf/5/1/4/9/HFS.pdf (Accessed: August 18, 2011)

Durham Region Health Department, Oral Health Brochure, Different Ages/Different Stages, Birth to 12 years,
http://www.durham.ca/departments/health/dental/agesStagesBrochure.pdf (Accessed: September 8, 2011)

A Message from the Chief Public Health Officer, Water Fluoridation, September 13, 2011, http://www.phacaspc.gc.ca/cpho-acsp/statements/20110913-eng.php, (Accessed: October 27, 2011)

The Ontario Medical Association, Water Fluoridation, October 2010,
https://www.oma.org/HealthPromotion/fluoridation/Pages/default.aspx (Accessed: October 27, 2011)
For more information on fluoride or other oral health concerns, contact Durham Region Health
Department, Oral Health Division, 905-723-1365 or 1-866-853-1326.
November 8, 2011
For more information
DURHAM REGION HEALTH DEPARTMENT
905-666-6241
1-800-841-2729 or durham.ca
If you require this information in an accessible format, contact 1-800-841-2729.