Many people take for granted the addition of fluoride into public drinking water systems that aims to prevent tooth decay.
The U.S. Centers for Disease Control and Prevention considers it to be one of the 10 top public health achievements of the 20th century and it is backed by the American Dental Association and the World Health Organization.
But fluoridation is not nearly as universally accepted and practiced as one might think – often because of public perceptions that it is harmful, not cost-effective or no longer necessary.
At least seven cities or towns across the country debated the issue just this summer.
In Healdsburg, Calif., voters will revisit a ballot question in November regarding whether to stop adding the mineral to the water supply. In fact, Healdsburg is the only city in Sonoma County that currently adds fluoride to its water. The city of about 11,000 people has done so since the 1950s, according to city clerk Maria Curial.
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The Healdsburg ballot measure would require that a toxicological report confirm the safety of fluoridating chemicals used in the city’s water. But examining every batch of these chemicals is not realistic, Curiel said, and the measure ultimately would force the city to stop fluoridation.
California law requires water systems with 10,000 or more service connections to fluoridate water. But suppliers must find their own funding to fluoridate, so it doesn’t always happen right away.
San Jose, with a population of more than 1 million, is the largest metropolitan city in the country that does not fluoridate its water. The Santa Clara Valley Water District, which provides the city’s water, will only begin delivering fluoridated water in some areas this coming December, after many years of debate and four years after district officials first voted to go ahead. The district has since been raising money and retrofitting water plants to prepare for the change.
Dr. Sara Cody, the Santa Clara County public health director, explained that cities in the county receive their water from different sources, and while neighboring cities have fluoridated water, San Jose has been the exception.
Communities such as East San Jose, a traditionally low-income neighborhood, tend to have worse health outcomes, Cody said. Those are the communities that would benefit most from community fluoridation, she said. “If everyone had access to regular dental care, that would be great, but that’s not the world we live in,” Cody said.
“There has always been periodic discussion,” said Steven Levy, a dentistry professor at the University of Iowa. Levy is involved in an Iowa-based longitudinal study that tracks fluoride intake and its effects on children’s bones. “We are seeing more challenges now because of the communication explosion with the internet.”
The debate over fluoridation started well before 1945 when Grand Rapids, Mich., became the first U.S. city to add fluoride to its water supply. In the decades since, opposition usually has stemmed from concerns that fluoride intake by children lowers IQs, creates higher rates of attention deficit/hyperactivity disorder and can lead to toxicity.
Although fluoridation has become a fairly common practice, with about 74 percent of the population receiving fluoridated water from community water systems, the intervention continues to raise grassroots concerns. These arguments range from casting fluoride as unnecessary and ineffective to portraying the mineral as “mass medication” and a “damaging environmental pollutant.”
“Fluoridation is not safe or cost-effective,” said Bill Osmunson, director of the Fluoride Action Network, a national organization against fluoridation of water supplies, adding that people should be given the freedom to decide so they can avoid ingesting excess fluoride.
