The end of the world is not something we like to contemplate, but Stanley Kubrick’s 1964 film Dr. Strangelove makes comedy out of it. The deranged General Ripper orders his B-52 squadron to drop nuclear bombs on Russia. The Russian response, the Doomsday Machine, will enshroud the Earth in radiation and kill “all human and animal life.” Group Captain Mandrake (Peter Sellers) desperately reasons with the general to give him the code to recall the bombers. In an unguarded moment, Ripper admits to Mandrake why he ordered the air strike: fluoride in the water. “Mandrake, do you realize that in addition to fluoridating water, why there are studies underway to fluoridate salt, flour, fruit juices, soup, sugar, milk...ice cream. Ice cream, Mandrake, children’s ice cream.” Fluoridation, he says, is a communist plot to deplete “our precious bodily fluids”:

Mandrake: When did you first. . .become. . .well, develop this theory?

Ripper: I first became aware of it, Mandrake, during the physical act of love. Luckily I was able to interpret these feelings correctly. Loss of essence.

Mandrake: Hmm.

Ripper: I can assure you that it has not recurred, Mandrake. Women sense my power and they seek the life essence. I do not avoid women, Mandrake.

Mandrake: No.

Ripper: But I...I do deny them my essence.

As a joke, it’s still funny today, partly because of the absurdity, partly because fluoridation is a subject most of us don’t give a hoot about. But there are people who, like Captain Mandrake, care a great deal. A Google search on fluoridation produces some 950,000 hits. Some of these sites associate fluoridation with health problems such as cancer, arthritis and, yes, impotency. You’ll find suggestions that Nazi prison camps “mass-medicated” inmates with fluoridated water in a bid “to sterilize humans and force them into calm submission.” Other sites claim that fluoridation is intended to lobotomize the population. Alongside these anti-fluoridation sites are portals like the American Dental Association and the Centers for Disease Control and Prevention, trumpeting fluoridation as effective and safe.

Water fluoridation, a measure that ostensibly protects us against tooth decay by adding small quantities of fluoride salts to the water supply, began in 1945 in such cities as Grand Rapids, Michigan, and Brantford, Ontario. It’s a fascinating story, complete with tie-ins to the American war effort, the atom bomb (fluoride was used to enrich uranium) and one of the most amazing public relations coups of the last century. Against the endorsements of prestigious medical and dental associations, a small coalition fought on “to keep our water pure.” Among those were right-wing groups such as the Ku Klux Klan and the John Birch Society. The debate rages on today—in black and white, just like the 1964 movie—with neither side granting any quarter. And as the last large city in North America not to fluoridate its water, Montreal finds itself at the centre of this fight.

Fluoride is a naturally occurring element in the Earth’s crust and is found in varying concentrations in drinking water around the world. Montreal tap water has some 0.2 parts per million (ppm); fluoridation proponents would like this “enriched” to an optimum amount of 0.7-1.2 ppm. The figure is based on studies of the “Colorado Brown Stain.” In 1916, a dentist named Frederick S. McKay co-authored a paper contending that something in drinking water near Colorado Springs was causing locals to have discoloured teeth but very little tooth decay. Further investigation revealed that the discoloration, a condition also known as enamel fluorosis, was caused by an overdose of fluoride in the drinking water. Over the following decades, research was conducted to determine if lower doses of fluoride could confer a protective effect to teeth without provoking fluorosis. Proponents of water fluoridation today claim that 0.7 ppm will do exactly that.

To opponents of fluoride, the stuff is rat poison. One Internet site quotes Fluoride the Aging Factor, by Dr. John Yiamouyiannis: “The 1984 issue of Clinical Toxicology of Commercial Products lists fluoride as more poisonous than lead and just slightly less poisonous than arsenic. It has been used as a pesticide for mice, rats and other small pests.” Opponents of fluoridation often point out that sodium fluoride is a waste product of the aluminum and fertilizer industries. It was very convenient for these industries, they say, that municipalities and toothpaste companies began buying their waste a few decades ago. Or, as Tom Lehrer sang in 1965: “Pollution, pollution/ You can use the latest toothpaste/ And then rinse your mouth with industrial waste.” Fluoridated toothpaste now carries a poison label in the US and can contain up to 1,500 ppm of fluoride.

Edward Bernays (1891-1995) was a key character in getting the public to accept water fluoridation. Often described as “the father of public relations,” Bernays applied the theories of his uncle, Sigmund Freud, to mass psychology. Among his other notable successes were persuading the American public to support World War I efforts “to make the world safe for democracy,” promoting cigarette smoking to women and convincing the masses to eat bacon for breakfast.  Bernays also highlighted the presence of groups such as the Ku Klux Klan among the ranks of those opposed to fluoridation, and shifted public opinion in favour of the practice, at least in North America.

Montreal remains the exception. Its fluoridation-free existence is due largely to Jean Drapeau, who was the city’s mayor almost continuously between 1954 and 1986. Drapeau is best known for his role in Expo 67, the 1976 Olympics, and creating the subway system. But he also strongly opposed fluoridation and resisted a provincial law requiring the city to fluoridate.

References to Drapeau’s philosophy on fluoridation are surprisingly scarce, but as cited in a 1973 document by naturopath Jean-Marc Brunet, Drapeau did not officially question the claim made by dental and medical authorities. He simply believed it to be morally wrong to impose medication on a local population. Jean Doré, elected mayor in 1986, promised to follow through on fluoridation but after encountering vigorous opposition during public hearings on the subject, let the issue languish. Pierre Bourque defeated Doré in 1994 and served as mayor until 2001 when Gérald Tremblay replaced him. Bourque did promise fluoridation during the 2005 campaign but lost in his bid to regain the mayoralty.

Making the case for fluoridation in Montreal is The Healthy Teeth Coalition. Dr. Stéphane Schwartz, president of the coalition, directs the Montreal Children’s Hospital dental clinic. Schwartz, who describes herself as “a white-haired grandmother,” spoke about young patients from Little Burgundy and Point St. Charles, some of the poorest neighbourhoods in Montreal. Cavities, she argues, are strongly correlated with poverty: some 70 percent of children four years old and younger from these areas suffer cavities, and the problem is growing worse. She makes a habit of showing photos of these children’s teeth to incredulous dentists from out of the area. Schwartz declares that “the mouth is the dirtiest part of the whole body, more so than the anus,” and that chronic infections of the mouth are often passed from mother to child.

The impact of poor oral health is significant.  “Children with bad teeth might not complain, but they can lose weight and behave badly,” Schwartz says. Mothers with poor teeth are more likely to have premature babies. She speaks of a possible correlation with Alzheimer’s disease and how oral infections can migrate into the bloodstream to become fatal. Some Montreal children must be put under general anaesthetic before dental work can be done and the wait time for this procedure is typically eighteen months. Schwartz passionately believes that it is our social responsibility to help these children through fluoridation. Alternatives, such as sending dental hygienists into schools and day cares, are no longer effective. “Fluoride is not a miracle, but it does make the problem less acute,” she says.

Schwartz studied dentistry in the 1970s in Boston, which was not then fluoridating its water. She is still in touch with colleagues there who tell her that it can be difficult for dentistry students today to learn their skills. The oral health of Boston children has so dramatically improved since water there was fluoridated that sometimes there are not enough patients on whom to practice.

Yet the polarity of this debate is such that most fluoridation opponents deny that fluoride in the water prevents cavities. They concede that topical application of fluoride kills cavity-causing bacteria on contact, but claim that ingesting fluoride serves no purpose. Mireille Guay, a Ph.D. in organic chemistry who teaches the subject in Sherbrooke, goes a step further and claims that fluoride serves no purpose at all. In an email interview, Guay says that upon verifying the studies that support fluoridation, she found that it was actually magnesium and strontium that conferred the protective effect attributed to fluoride. Guay underlines the importance of going to the source study rather than relying on reviews.

Marcel Tenenbaum, the dental consultant at the Montreal Public Health Department in charge of fluoridation,  is  a strong ally of Schwartz. He claims that “children don’t vote and they need water fluoridation. Why punish the children?” A Holocaust survivor, Tenenbaum wrote the website of the Montreal Public Health Department. Tenenbaum, who writes more provocatively in the French-language version of the website (to “redress a lack of information in that language”), argues that water fluoridation is effective and safe and that 27,000 health studies back this up. “Fluoridation is one of the greatest achievements of public health in the 20th century,” claims the website. It goes on to accuse the present city government of Gerald Tremblay of “passive dental negligence” by not taking action.

Tenenbaum describes fluoridation opponents as trying to create doubt and instil fear: “Part of the problem is that journalists try to present both sides of the argument, giving the impression that there is equal weight of evidence both for and against fluoridation. When people are in doubt, they opt for the status quo.” He adds that this often causes support for fluoridation to drop as the public debate heats up.

Tenenbaum likes to remind people that fluoride is naturally present in drinking water. (“Nature thought of it first,” as he puts it.) He suggests that adding fluoride to drinking water is analogous to adding iodine to salt. Tenenbaum asserts that the minute quantities of fluoride added to public water cannot produce the effects that detractors claim. While ridiculing their arguments, Tenenbaum admits the anti-fluoridation forces are formidable. “They are well organized and have lots of money,” he says, citing in particular the US-based Fluoride Action Network (FAN).

FAN, based in Burlington, Vermont, is a leading group opposed to fluoridation in the United States. Project director Michael Connett claims that the sixty-year-old debate is heating up again, especially on the heels of the “recent disclosure that Harvard University’s dental college suppressed a study linking fluoridation to osteosarcoma [bone cancer] in boys.” Connett confirms that Montreal is the largest North American city not to fluoridate, but pointed out that Vancouver does not either, and that its dental health is among the best in Canada. He further asks, considering fluoridation is rare in western Europe, why western Europe and North America have reported similar improvements in dental health over recent decades.

Fluoridation “has been increased by edict,” not by popular support, says Connett. He mentions that six out of seven North American cities rejected fluoridation in November 2005 plebiscites. Connett claims the fluoridation camp in Bellingham, Washington, spent more money on its plebiscite than FAN can raise in a year. FAN membership includes environmentalists and open-minded health practitioners, such as naturopaths. When asked if he had seen Dr. Strangelove, Connett begins laughing and quips, “one of FAN’s goals is to deconstruct the image painted by our movement’s association with the John Birch Society.”

Pierre-Jean Morin, a retired high-ranking bureaucrat in the Quebec Ministry of Health (MSSS) and former research director at Laval Hospital, is a co-author of Fluoridation: Autopsy of a Scientific Error. He has a PhD in experimental medicine and has been called as an expert witness at a fluoridation trial in the United States. When I call him, I expect Morin to plug his own work, but he speaks instead about Christopher Bryson’s book Fluoride Deception, which chronicles how fluoridation was a plot of the US government, the CIA and the aluminum industry. American aluminum production was crucial to the Allied victory in World War II, but workers were exposed to dangerous waste amounts of fluoride, a by-product of the smelting process. Oscar Ewing, chief counsel of Alcoa, became head of the Federal Security Agency (to which the United States Public Health Service reported)  in 1947 and encouraged the American Dental Association to endorse fluoridation. At that time, laboratories promoting fluoridation were supported by the aluminium industry. And although allegations abound that data was fudged from the original studies supporting fluoridation, the argument that fluoride “was safe enough to put into drinking water” did much to discredit group action lawsuits by aluminum workers. 

Morin claims that many scientists question or oppose fluoridation but that they can face intimidation, censorship, sanctions, or even be fired for speaking their minds. Morin gives me specific names and dates (many of the salient charges are listed on the Fluoride Action Network website), and adds that, during his public career, he has received three muzzle orders not to talk to the press because of his opposition to fluoridation. When I ask if he sees any credibility in the health claims made by the fluoridation lobby, Morin replies that their arguments do not stand up to cross-examination in court and, as a result, the anti-fluoridation forces have won every trial to date.

Another intriguing opponent of fluoridation is Pierre Larose, a Ville St. Laurent dentist I first heard described as “the dentist with an anti-fluoridation poster in his dental office.” Larose is a holistic dentist and offers homeopathy as an alternative to Valium. Larose originally supported fluoridation but changed his thinking in the 1980s and 1990s. Despite believing that fluoride can sometimes be useful in preventing tooth decay, Larose rarely uses fluoride, believing that Montrealers are already overdosed with it. He says that the “optimal” dose of fluoride is one milligram per day for an adult, but that we are receiving about four times this dose by swallowing toothpaste and ingesting processed foods prepared with fluoridated water. Larose describes his adversaries as “sincere but outdated. Most of them continue to repeat what they were taught in school and do not look at the new science available.”

Yet Dr. Michael Levy, who like Larose claims to stick to the science and steer clear of the politics, arrives at the opposite conclusion. A member of The Healthy Teeth Coalition and a dental consultant at the Laboratoire de santé publique du Québec, Levy laments the lack of fluoridation in Quebec drinking water. We talk about a study showing the rate of cavities by district of Montreal comparing very unfavourably to the suburb of Dorval, which stopped fluoridating its water in 2003. “Quebec has the worst teeth in the country according to Health Canada,” he says.

Like Dr. Schwartz, Levy ties oral health to general health. He points out that Quebecers spend some $1.8 billion a year on dental care and that fluoridation offers potential savings of a few hundred million dollars. He cites a 1978 Consumer Reports article that considers the anti-fluoridation movement to be “the greatest triumph of quackery over science in the 20th century.” He asks how prestigious groups such as the World Health Organization and the American Medical Association could be involved in a conspiracy.

Levy describes a naturally occurring “fluoride belt” stretching from central Africa to India that has very high fluoride levels in its drinking water. This same area, he says, exhibits very low cancer rates: “Lake Victoria is the cradle of humanity and people have been living there for at least a million years, yet it has a very high rate of natural fluoridation. So, to me, there is no biological plausibility that there could be a link with cancer.” Referring to the Harvard study on osteosarcoma, Levy points out that this was not a peer-reviewed study and that the number of subjects was small. He also takes issue with the contention that local aluminum and fertilizer companies profit from selling fluoride to municipal water treatment plants, pointing out that North American sources found it unprofitable to produce such fluoride. Fluoride used for municipal fluoridation in Quebec is currently imported from Asia.

“Please excuse the pun, but their arguments don’t hold water!” jokes Levy. He followed up on our interview by sending me a National Inquirer-esque story entitled “Space Aliens Are Here for Our Toothpaste!” in which British “exo-odontologist” Dr. Alan Prestwood explains UFO sightings as an alien quest for whiter teeth. “We are thousands of years behind the extraterrestrials in space travel, but we’re way ahead of them in dental hygiene,” Prestwood says.

But do crackpot theories about UFOs detract from the science behind anti-fluoridation arguments? Ironically, each side accuses the other of being unscientific. “A scientist is trained to accept the possibility that his hypothesis could be false,” says Mireille Guay. “By looking at the science objectively, I found that the fluoride does not really protect teeth, and I therefore changed my thinking on this…We have to understand what errors may have been made in order to more closely approach what is the truth.”

The mutual distrust within the fluoride debate is reminiscent of Dr. Strangelove in another way: each side sees itself as a freedom-loving America and its opponents as a bunch of ideological Commie Reds. And the vigour of the debate, ironically, ensures stasis in Montreal’s civic policy. The last bastion of un-fluoridated drinking water in North America is still la belle ville.