Formal Complaint re: Peel Medical Officer & Health Commissioner & 2017 Oral Health Report

Email of Feb 24, 2017
Subject: Formal Complaint re: issues with Peel Public Health’s new Oral Health report

Dear CAO Szwarc,

Dr. de Villa and Health Commissioner Polsinelli have failed to acknowledge my serious concerns conveyed to them on Feb. 10 2017, shown further below.

Please consider this email a formal complaint.

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Please also note that in the previous public health report of 2003, dental fluorosis was more appropriately reported for children ages 7, 9, 11, and 13, not children in JK, SK and grade 2.

In addition to the queries I already made to Dr. de Villa and Health Commissioner Polsinelli, the public needs an explanation of:

1) why “Routine data about the oral health status of Peel’s population is limited to children in junior kindergarten (JK), senior kindergarten (SK) and Grade 2″ and, more specifically, why data has not been collected on older children who have the teeth necessary for proper evaluation of dental fluorosis, especially given that most of Peel’s municipal drinking water is fluoridated;

2) whether the Region has any post-2001/2 data on dental fuorosis and, if so, why it has not been made publicly available and whether it will now be made available;

3) why Public Health stopped reporting on dental fluorosis years ago and who was responsible for this decision.

Best wishes,
Christine
Fluoride Free Peel

On Fri, Feb 17, 2017 at 10:41 AM, Christine Massey <cmssyc@gmail.com> wrote:
> Dear Dr. de Villa and Health Commissioner Polsinelli,
>
> It has been one week since my query below, and I have received no reply from
> either of you. If I don’t hear from you by early next week I will be forced
> to escalate this issue to the proper authorities.
>
> Best wishes,
> Christine
> Fluoride Free Peel
>
>
> On Fri, Feb 10, 2017 at 3:15 PM, Christine Massey <cmssyc@gmail.com> wrote:
>>

Dear Dr. de Villa and Health Commissioner Polsinelli,

On January 30, 2017 you reported, I believe to Council, ‘highlights’ of a new report from Peel Public Health entitled Oral Health in Peel: A Taste of Risk Factors and Oral Health Outcomes.

This report has just been released to the public and I am very concerned about its contents regarding dental fluorosis. Specifically, I am concerned that results have been reported in a way that is misleading, and possibly even fraudulent.

1.
On page 61 it provides the CHMS survey’s Canada-wide results on dental fluorosis for children aged six to 12 years, a group that is older than the Peel children that are reported on.

Also, at the time of the CHMS survey only 45% of Canadians had fluoridated water (the rate is now closer to 30%), while the majority of Peel’s residents had and continue to have fluoridated water. The rate of dental fluorosis in Peel can therefore be expected to be potentially much higher if/when the same age groups are examined.

The report does not explain this, only that “the data from the Canadian Health Measure Survey (CHMS) cannot be compared to Peel data.” I believe that this very relevant information needs to be pointed out on page 61.

Also on page 61, it states that “Most commonly, this presents as small white specks on a child’s teeth.” It neglects to inform that pitted brown staining may also occur. I believe this needs to be rectified.

3.
It states on page 42 that “Routine data about the oral health status of Peel’s population is limited to children in junior kindergarten (JK), senior kindergarten (SK) and Grade 2.”

The report also states on page 61 the following:

“In Peel, dental fluorosis affects about 2.1% (representing 1,113 children) of the 52,462 children that were screened during the 2014-2015 school year.”

No other information is provided except that “Data are not available for Peel youth or adults.”

My understanding is that the vast majority of children in JK and SK would not even have any permanent front teeth to look at, and even a lot of the children in Grade 2 would not yet have any anterior permanent teeth to look at.

Supposing that 33% of the examined children were in grade 2, and half of them had all of their front permanent teeth visible, that would mean that only 16.5% of the 52,462 children could actually be properly evaluated for fluorosis. If 40% of that 16.5% had any fluorosis, then 6.6% of the original 52,462 children had fluorosis. And if the really mild and questionable cases of fluorosis were ignored, then fluorosis being found in only 2.1% of the original 52,462 children would be understandable. Yet to report the results as “dental fluorosis affects about 2.1% (representing 1,113 children) of the 52,462 children that were screened” would be incredibly misleading, unscientific, and in my opinion possibly qualifying as scientific fraud.

Is this, or something similar, what happened?

Please let me know the details of how the fluorosis diagnoses were carried out.

Please also let me know how many JK, SK and Grade 2 children were examined, how many in each age group had the teeth to be evaluated for fluorosis, the number in each age group with fluorosis, the degrees of fluorosis recorded, and whether any of the 1113 kids with fluorosis were from higher grades.

All of these important pieces of information need to be included in the Fluorosis section of the report, so that the Region provides meaningful rather than misleading and/or confusing information.

I respectfully request that the report be removed from the Region’s public webpage, and Staff webpages, until these issues have been adequately addressed. I also request that all parties to whom this report has been distributed are made aware of these serious issues.

Best wishes,
Christine
Fluoride Free Peel