Tooth decay is on the rise in Canadian cities that have abandoned water fluoridation, sparking concerns among oral health experts. In late 2024, Montreal announced it would stop adding fluoride to two of its water treatment plants, marking a significant policy shift. While fluoride has long been recognized as a cost-effective public health measure to reduce dental caries, political debates and misinformation campaigns—fueled in part by U.S. presidential candidate Robert F. Kennedy Jr.—are pushing more municipalities to drop fluoridation.
Fluoride and Its Role in Public Health
Fluoride is widely regarded as one of the most effective ways to prevent cavities, reducing childhood tooth decay by 25%. Yet, while nearly 75% of Americans have access to fluoridated water, only 38.8% of Canadians do. Provinces like Quebec and British Columbia have overwhelmingly rejected fluoridation, despite evidence linking its absence to worsening oral health outcomes.
Experts point to real-world examples: Calgary stopped fluoridating its water in 2011, leading to a documented increase in cavities among children. A comparative study showed that second-grade students in non-fluoridated Calgary had a 64.8% prevalence of dental caries, compared to 55.1% in fluoridated Edmonton. Following a 700% increase in children requiring IV antibiotics for severe dental infections, Calgary reversed its decision and is set to reintroduce fluoride in 2025.
The Influence of RFK Jr. and Anti-Fluoride Activism
Robert F. Kennedy Jr., a known vaccine skeptic, has also positioned himself against fluoride, falsely claiming it causes cognitive decline, arthritis, and even cancer. His rhetoric has emboldened anti-fluoride activists across North America. In Montreal, a petition backed by Kennedy’s supporters played a role in the city’s decision to end fluoridation, despite overwhelming scientific evidence supporting its safety.
Canadian dentists and public health officials warn that fluoridation is a crucial measure to address disparities in oral health. Lower-income families, who are already twice as likely to suffer from untreated dental issues, are disproportionately affected by the removal of fluoride.
Fluoridation vs. Budget Constraints
Fluoridation isn’t just a health issue—it’s also a financial one. Cities must weigh the cost of fluoridation against the burden of rising dental disease. Calgary estimates that restoring fluoride will cost $28 million initially, with an annual maintenance cost of $1 million. Windsor, Ontario, expects to spend $850,000 to reinstate fluoride, plus $150,000 per year for upkeep.
Yet, for every $1 spent on fluoridation, between $15 and $35 is saved in dental treatment costs. This financial argument has led some Canadian municipalities, like Windsor and Kingston, to reconsider fluoridation after witnessing increased tooth decay rates post-removal.
The Future of Fluoridation in Canada and the U.S.
As Montreal’s decision reverberates across Canada, it raises concerns about the future of fluoride policies in the U.S. If Kennedy, who has been tapped by Donald Trump as a potential health secretary, gains influence, could America see a rollback in fluoridation?
Public health experts urge municipal leaders to rely on science, not misinformation. Fluoride remains a vital tool in the fight against dental decay, especially for vulnerable populations with limited access to dental care. As cities debate fluoridation policies, the stakes for public health—and for the next generation’s oral health—couldn’t be higher.