How does adding fluoride to drinking water affect the health of residents living in the city, and is it a wise decision to add fluoridate drinking water?

1. Researching what exactly fluoride is\, and what it is used for. 2. Researching the different opinions on fluoride\, and fluoridating water. 3. Interviewing an expert on dental health (dentist) to see his opinion on fluoride and fluoridating water. 4. Use this information to try to determine if it is wise to fluoridate drinking water.

Fluorine (F)  is the 9th element on the periodic table, and is a halogen that is dangerous in its natural gas form. When fluorine picks up another electron it makes fluoride (F⁻). This is a compound, and can be added to things in the form of either fluorosilicic acid, sodium fluoride, or sodium fluorosilicate. It is commonly found in dental products, and in minimal amounts in some foods. It can also be added to drinking water, which is the subject of this project.  Fluoride is used in many dental products, including toothpaste, and fluoride mouth washes. This is because fluoride reduces the risk of cavities by strengthening tooth enamel. Our teeth have a protective layer around them called ‘enamel’. This enamel is constantly gaining minerals through remineralization, and losing them through demineralization. Demineralization occurs when tooth enamel is worn down by acids created by bacteria, sugar, and plaque. Remineralization occurs when the minerals in your enamel are replenished by calcium, fluoride, and phosphates. When the rate of demineralization is greater than the rate of remineralization, cavities result as the acids create a hole in your tooth. Fluoride prevents cavities by remineralizing tooth enamel, preventing the growth of bacteria, and even reversing early tooth decay. However, fluoride can also have negative effects on teeth. Fluorosis occurs from an overexposure to fluoride, and takes two main forms. The first is dental fluorosis, which is a cosmetic concern where your teeth have white spots and streaks on them. Dental fluorosis occurs when a large amount of fluoride is ingested between the ages of 0-8, while permanent teeth are still forming. Skeletal fluorosis, however, is more serious, and occurs due to an overexposure to fluoride over many years. Skeletal fluorosis is a result of a build-up of fluoride in bones, which can cause joint stiffness, as well as brittle and weak bones. If left untreated, skeletal fluorosis can result in arthritis, chronic joint pain, and osteoporosis (a condition where your bones have a lower bone density).  Many of these conditions can be prevented by following health guidelines. The optimal fluoride level for drinking water advised by Health Canada is 0.7 g/mL. The maximum fluoride level for drinking water is 1.5 g/mL. Most, if not all, cities who add fluoride to their drinking water do follow these guidelines. However, there are some communities with natural groundwater fluoridation  Many towns have added fluoride to their drinking water in an effort to reduce dental problems in their municipalities. In Alberta, some of these major cities include Edmonton, Lethbridge, and, most recently, Calgary.  Fluoridation levels across Canada vary widely. As you can see from this diagram, as of 2022, Ontario had the highest amount of fluoridated water systems at 73.2% while Newfoundland and Labrador, and the Yukon had the lowest at 0%. Alberta lands in the middle with 43%. This means that 43% of the water systems in Alberta are fluoridated. 

As part of my research, I interviewed a dentist who works in a local clinic in Okotoks. I have attached a recording of my interview (in the attachments). Questions: 1. What are some of the benefits you've seen from fluoride? 2. What are some of the negative effects you've seen from fluoride? 3. In your professional opinion\, is it necessary to fluoridate drinking water? 4. Do you think there should be a minimum age for fluoride? 5. Do you know if there is a reason for the fluctuation of public opinion in the past? 6. Is there a good/better alternative to fluoride? 7. Do you think it's necessary to fluoridate water\, or do you think kids already have enough fluoride with their toothpaste. 8. Do you have any more comments about fluoride?

Answers (Dr. Brandon Comfort) 1. Fluoride is a vetted treatment against cavities/caries. It strengthens bonds within teeth. People that care for their teeth well (usually using a over-the-counter fluoride toothpaste), tend to have less of a cavity risk than those who do not have a fluoride toothpaste. There are also other products that have great effects in preventing cavities. 2. Fluorosis- gives distinct appearance to someone's teeth, a cosmetic concern. Other arguments are that over-exposure to fluoride cause medical defects, or developmental defects, but these aren't necessarily seen in the dental field. 3. Yes, the pros outweigh the cons in the dental field. Fluoride/dental compound does prevent cavities, and the negative effects can be avoided by the proper use and amount of the fluoridated product. A negative outcome can come from young children eating fluoridated toothpaste, and becoming quite ill. 4. Depends on the specific patient risk, so it is not cut and dry. If young child, (around 2 years old), is already showing signs of cavities, a fluoridated toothpaste would most likely be the wisest. But, if there is a young child that is at a very low risk for cavities, and doesn't show dental decay, a minimal amount of fluoridated toothpaste, or another toothpaste that has a different compound would be recommended. 5. Don't quite know, couldn't cite specific new studies. Not likely a breakthrough in the benefits of fluoride. More studies are coming out about the effectiveness of fluoride alternatives. 6. Nano-hydroxyapatite. This is what teeth enamel is made of, so instead of strengthening the bonds within teeth like fluoride, nano-hydroxyapatite replenishes the mineral with in your teeth. It is a great alternative, but couldn't be put into a water system like fluoride. Studies are showing that it looks promising to be equal with fluoride, it is an excellent alternative for people who do not like fluoride, or children who are prone to swallowing fluoride in toothpaste. 7. There are varying opinions. It can be argued that putting fluoride into water takes away the choice of a person who doesn't necessarily want to ingest fluoride. People should be educated on what fluoride is, and should have the choice of deciding whether or not to put it in their body. Fluoride in drinking water does benefit teeth, but it is very easy to get fluoride to help your teeth through dental products. It is important that we educate people about the negative effects of fluoride. We should be honest that there can be negative effects, but these negative effects come from ingesting a large volume of fluoride. 8. As a dentist, there are definite proven benefits of fluoride in fighting tooth decay. The reason for fluoride in our drinking water is that it is a public health initiative, and they are trying to find a low cost way to reduce cavities in people, and especially in children. The debate is about the negative effects of fluoride for our systemic health, and whether or not it is ethical to put a medication or compound in drinking water.

My conclusion is that the benefits of fluoride on dental health are definite, and, in optimal amounts, there can be benefits to public dental health if we fluoridate water. However, the negative effects of fluoride need to be more thoroughly researched, and it may not be ethical to publicly medicate drinking water. I think that there should be more education on fluoride, in schools and public news so that people can decide for themselves whether or not they want to use fluoride. I think that fluoridating drinking water isn't necessary if we provide this education, and encourage people to take their own dental health seriously. We should also put more research into alternatives for fluoride, and inform the public about these alternatives, and their benefits and consequences.

Brazier, Y. (July 14, 2025). What are the benefits, risks, and uses of fluoride? https://www.medicalnewstoday.com/articles/154164 Office of the Chief Dental Officer of Canada, Public Health Agency of Canada. (December 12, 2022). The State of Community Water Fluoridation across Canada https://www.canada.ca/en/public-health/services/publications/healthy-living/community-water-fluoridation-across-canada.html Deziel, N. (February 2025). Fluoride https://ysph.yale.edu/research/information-sheets/fluoride/#what-happens-when-you-get-too-much-fluoride? Fluoride (January 12, 2026). https://my.clevelandclinic.org/health/treatments/11195-fluoride Cavities (March 27, 2023). https://my.clevelandclinic.org/health/diseases/10946-cavities Fluorosis (October 14, 2024) https://my.clevelandclinic.org/health/diseases/23227-fluorosis Osteoporosis (November 26, 2025) https://my.clevelandclinic.org/health/diseases/4443-osteoporosis Inadequate or excess fluoride https://www.who.int/teams/environment-climate-change-and-health/chemical-safety-and-health/health-impacts/chemicals/inadequate-or-excess-fluoride Environmental Public Health, Alberta Health Services (December 16, 2024) High levels of fluoride in drinking water https://myhealth.alberta.ca/Alberta/Pages/High-Levels-of-Fluoride-in-Drinking-Water.aspx American Cancer Society (November 18, 2022). Water Fluoridation and Cancer Risk https://www.cancer.org/cancer/risk-prevention/chemicals/water-fluoridation-and-cancer-risk.html#:~:text=If%20someone%20is%20exposed%20to,or%20fractures%20in%20older%20adults. Health Canada (December 2010). Guidelines for Canadian Drinking Water Quality: Guideline Technical Document – Fluoride https://www.canada.ca/en/health-canada/services/publications/healthy-living/guidelines-canadian-drinking-water-quality-guideline-technical-document-fluoride.html Fluoride in drinking water https://www.epcor.com/ca/en/ab/edmonton/safety/water-quality/fluoride-drinking-water.html#:~:text=EPCOR%20has%20been%20fluoridating%20Edmonton's,levels%20of%20approximately%200.1%20ppm. What is Water Fluoridation https://fluoridealert.org/key-topics/what-is-water-fluoridation/ Iheazor-Ejiofor, Z., et al. (June 18, 2015). Water fluoridation for the prevention of dental caries https://pmc.ncbi.nlm.nih.gov/articles/PMC6953324/#abstract1 Fluoride in Calgary's Water https://www.calgary.ca/water/drinking-water/fluoride.html#history Krol, C. (September 2, 2021). What is Fluoride? Benefits, Risks, and Uses https://truthaboutfluoride.com/what-is-fluoride/ Burger, D. (August 10, 2021). A tale of two cities finds that community water fluoridation prevents caries https://adanews.ada.org/ada-news/2021/august/community-water-fluoridation-prevents-caries/ Comfort, B. Dentist. Okotoks Dental, Okotoks, AB. Pers. Comm., February 23, 2026.

I would like to thank my parents for their support and encouragement. I would also like to thank my science teacher, Mr. Kroeker, for giving me this idea, and the many resources he has given me. Also thank you to Dr. Comfort for taking time out of his busy day to speak to me.