Water Fluoridation: Frequently Asked Questions
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Water Fluoridation: Frequently Asked Questions

What is “water fluoridation”?

Nature puts some fluoride into all of the world’s drinking water. Some areas in Canada have enough natural fluoride in their water to help prevent tooth decay. Fluoride naturally exists at varying levels throughout BC (Reference).

What is “community water fluoridation”?

Community water fluoridation is the process of adjusting the natural level of fluoride in the water supply to the amount necessary for protection against tooth decay (caries) (Reference).

In Canada, the recommended amount of fluoride is 0.7 mg/L with a Maximum Acceptable Concentration (MAC) of 1.5 mg/L. In the United States, the MAC is 4 mg/L (Reference #11, p.8).

What are the benefits of fluoridation?

The Center for Disease Control and Prevention (CDC) says community water fluoridation prevents tooth decay and is one of the 10 great public health achievements of the 20th century (Reference).  

Is dental health important?

Yes. Oral health is related to overall health. Links exist between oral health and diabetes, heart disease, respiratory disease and low-birth weight and preterm babies.  Poor oral health can affect your appearance, self-esteem and ability to chew and digest food properly and has been linked to sleeping problems, as well as behavioural and developmental problems in children. (Reference).

Oral health is a factor or determinant that affects quality of life (Reference). Water fluoridation is a safe, efficient and effective way to reduce dental decay and help support better life chances, especially in our vulnerable populations.

Is dental decay still a serious problem?

Yes. The Canadian Dental Association states that dental disease is a growing concern (Reference). In addition, overall health is linked to oral health; poor oral health can affect or complicate other health issues (Reference).

How does fluoride protect teeth against tooth decay (caries)?

Fluoride remineralizes tooth surfaces, preventing tooth decay. Tooth decay is caused by certain bacteria in the mouth that produce acids when a person eats sugar and other refined carbohydrates. Acids remove minerals from the tooth surface which leads to tooth decay (Reference). Fluoride helps to remineralize or repair teeth that have initial, microscopic stages of tooth decay (Reference).

Do communities in Canada have fluoridated water?

Currently, over 13 million  people in Canada are receiving the benefits of water fluoridation. Manitoba, Ontario and the Northwest Terratories have the highest percentage of fluoridated water in Canada ranging from 61-75%. In BC, 53,000 residents benefit from fluoridated community water supplies.


Is it true that the fluoride used in Canada's drinking water is a hazardous waste?

This is FALSE!  The fluoridation additives certified for use in drinking water are safe and not classified as a hazardous waste (Reference). The Fluoride added to our water is intended for water fluoridation and is NSF certified, meaning it is safe for use with food products (Reference).

What is dental fluorosis? Should I be concerned about it?

Dental fluorosis (see picture) is an alteration in the appearance of teeth caused during tooth development and is related to ingesting higher than optimal levels of fluoride. (Reference pp.63-64)

Dental fluorosis (see table) ranging from questionable to moderate has no effect on tooth function. Diagnosis requires a trained dental professional to detect.

Dental fluorosis is not considered a concern in Canada. Moderate and severe fluorosis rarely occurs but may be found in certain immigrant populations that were exposed to high levels of fluoride before they arrived in Canada. (Reference pp. 63-64) (Reference)


Dean's Index Classification

Criteria - Description of enamel


Smooth, glossy, pale creamy-white translucent surface


A few white specks or white spots

Very Mild

Small opaque, paper-white areas covering less than 25% of the tooth surface


Opaque white areas covering less than 50% of the tooth surface


All tooth surfaces affected; marked wear on biting surfaces; brown stains may be present


All tooth surfaces affected; discrete or confluent pitting; brown stain present


What type of fluoride is added to our community water supply?

Hydrofluorosilicic acid (also known as fluorosilicic acid, dihydrogen hexaflorosilicate, hexafluorosilicic acid, hydrogen hexafluorosilicate or silicofluoric acid). (Reference p.2)

Are fluorosilicate compounds toxic in drinking water?

No, fluorosilicate compounds are not toxic in drinking water. Fluorosilicate compounds "readily hydrolyse completely to release fluoride ions" when added to water (Reference). This means that once it is added to water, the fluoride completely and easily dissolves, safely fluoridating our water supply.

Is hydrofluorosilicic acid a safe source of fluoride?

YES! Hydrofluorosilicic acid is intended for community water fluoridation. (Reference) and is a NSF (National Sanitation Foundation) Certified Product, meaning it is safe for use with food products (Reference).

What communities in Northern Health benefit from fluoridation?

Northern Health communities currently receiving the benefits of fluoridation to prevent dental decay are Fort St. John, Prince George and Terrace. These communities have an estimated population of 142,600 and have received the prevention benefits against tooth decay for the past half-century.

Why add fluoride to water when we can buy fluoride toothpaste and mouth rinses?

In BC, after paying for housing and food, low to moderate income individuals or families are often unable to afford anything else, including dental care or fluoride toothpaste and rinses (Reference p.7). Child poverty in BC is the second highest in the country (Reference p.2) and “dental disease is the number one chronic disease among children and adolescents in North America” (Reference).

Fluoridation helps prevent tooth decay in all ages, regardless of “socioeconomic status, education, or employment” (Reference).

How much does community water fluoridation cost?

It costs approximately $0.60 -$1.00 per person, per year for water fluoridation (Reference p. 453), which is much more economical than the cost of repairing a tooth with dental decay. Community water fluoridation is the most realistic way of reducing the heavy burden of dental decay.

Who benefits from fluoridation?

Everyone benefits from community water fluoridation. Fluoridation helps prevent tooth decay in all ages, regardless of “socioeconomic status, education, or employment” (Reference).

And who else benefits from community water fluoridation?

"The lowest incomes in Canada have the highest levels of oral disease, yet face the most barriers to accessing dental care” (Reference p.4).       

50% of Canadians with lower incomes do not have dental insurance. (Reference p.2)

In BC, after paying for shelter and food, low to moderate income individuals or families often cannot afford anything else, including dental care (Reference p.7). Tooth extraction is a common treatment for those with dental pain and/or infection, who are unable to afford dental treatment. Missing teeth leads to social stigmas, poor self-esteem, lost opportunities including chances for employment and other health and social problems (Reference).

Fluoridation reaches all residents in a community and reduces the risk of tooth decay. It benefits our most vulnerable individuals, including our children, our low and moderate income individuals, and our seniors (Reference). The World Health Organization (WHO) considers access to fluoride to be “part of the basic human right to life” (Reference).

How does fluoridation affect the children in our communities?

Child poverty in BC is the second highest in the country and “dental disease is the number one chronic disease among children and adolescents in North America” (Reference). In BC, the most common reason for children to have surgical procedures in hospital is due to dental disease (Reference).

In Northern Health, about 750 children, less than 10 years of age, are seen each year in hospital for dental surgery. This figure only accounts for the children who have been to a dentist, have been diagnosed and are able to access treatment.

Children drinking fluoridated water can expect up to 35% less tooth decay and will benefit throughout their lifetime with fewer cavities and missing teeth (Reference).

Is fluoridated water safe?

"Yes. The safety of fluoridation of public or community water supplies has been studied thoroughly as a public health measure. Since the 1940's, hundreds of scientific studies have shown that the use of fluoride for optimal dental health has no harmful effects." (Reference).

For more detailed information on each FAQ above, please click on the FAQ's "Reference" 

For information on Dental Health please see the Northern Health Dental Health Programs pages