Hernando County does not put fluoride into its public water supply.

The county utilities director opposes the idea as too costly and ineffective, and county commissioners routinely have followed her advice.

The last time commissioners gave fluoridation serious consideration was a dozen years ago, when they approved it. They quickly backed down, though, after public complaints mounted and a federal study showed possible links between fluoride and a rare form of bone cancer.

Still, whenever new commissioners get elected, a dedicated group of dentists and hygienists renews its push to fight tooth decay by adding fluoride to the water supply. This year is no exception.

“I have seen a high rate of decay among younger people and among older people in (previously) decayed areas,” said Spring Hill dentist Bryan Marshall, who sits on the county’s Health Care Advisory Board and represents the county on the North-Central Florida Health Planning Council.

Fluoride in the water would reduce the threat of decay by more than 50 percent, Marshall said. Long-term exposure to fluoride also cuts the risk of hip and vertebrae fractures in older women, according to a study recently published in the British Medical Journal, he added.

What is more, Marshall said, the Centers for Disease Control and Prevention rated fluoridation as one of the top 10 public heath advances of the 20th century.

Convincing local decision makers might prove difficult. Even the two nurses on the County Commission have shown an unwillingness to put money into the budget for fluoridation.

To shape the debate, Marshall and other dentists plan to mount a public education initiative and circulate a petition to show broad support for the idea.

“It’s a public health issue, although it’s a complicated issue here in Hernando County,” Marshall said. “It comes down to whether or not the Hernando County Commission has the political will to do it.”

As it stands, commissioners say they have the will but not the desire.

“The biggest thing is, it just goes down the tubes. (People) don’t drink the water as much as they flush the toilet and wash their dishes,” Commissioner Mary Aiken said.

Some people might favor fluoridation, Commissioner Diane Rowden said, but others do not want chemicals in their water. Both positions deserve equal consideration, she said.

“It has come up before. We just basically said, ‘We’re not interested,’ ” Chairman Chris Kingsley said. “You just need three people to listen, so they’re going to try again. If three people want to have fluoridation as an issue on the agenda, then I guess we will consider it. But it’s not something I would consider.”

The commissioners rely heavily on the opinion of Utilities Director Kay Adams, who said nothing would sway her belief that better ways exist to protect teeth than fluoride in the water supply.

Adams doesn’t resort to scare tactics in her opposition. She makes no claims that fluoridation is a plot to sedate people into compliance or that the chemical is toxic and carcinogenic, positions that critics have floated over the years.

In fact, she is among the first to say that fluoride does “wonders” for dental health. Instead, Adams points to the bottom line.

The capital cost of setting up a fluoridation program would be a minimum of $335,000, most likely more, she said. Annual operating costs, including sampling, permits and chemicals, would total $125,697.

“Ninety-nine percent of water goes down the drain or into lawns,” she said. That alone makes fluoridation a “waste of time and money. I just don’t see throwing that money out.”

She recommended supporting educational programs that teach children the benefit of using fluoride rinses.

Another concern Adams raised involved the large number of water plants where her staff would have to inject hydrofluorosilcic acid. The county has 27 plants, she said, which translates into 27 places where the corrosive acid could spill, causing problems for staff and possibly for customers.

“To me, there’s too many hazards,” Adams said. “Toothpastes and rinses and whatever are better.”

Those alternatives would help, Marshall said, but they also are more expensive.

He estimated that a person would need 7.6 bottles of rinse annually to have a benefit equal to fluoridation. The county water utility serves about 44,825 people, he said, so at $4 per bottle of rinse, the cost per year would be about $1.25-million.

The county’s “waste” would be closer to $14,000, he said.

“Basically, fluoride is the most cost-effective way to prevent dental decay,” said Harry Davis, a dentist and head of the state Public Health Dental Program. “For every $1 spent on fluoride, there’s $40 to $80 saved in dental costs. Over a lifetime, the cost of fluoride equals about the cost of one filling.”

As far as the danger of fluoride, Marshall said, “If you take it pure and drink it, yeah, it will kill you. But if you use it properly, it’s safe.”

The state has targeted Hernando County as one of the larger water utilities that needs to be fluoridated, Davis said.

It has money available to help with the start-up costs, he said, although the program has a waiting list.

To date, 116 public water utilities, including the city of Brooksville, are fluoridated, according to the state health department. Gainesville was the first to fluoridate, in 1949, and Bradenton the most recent, in 1999. Altogether, they serve more than 7.8-million residents.

Another 32 public utilities serving about 1.2-million residents have naturally occurring fluoride.

“We want to try to get it up to at least 75 percent of the population,” Davis said.

That won’t be an easy process in Hernando County, Marshall said. But he intends to give it a try, despite the opposition.

“There are some things that are not easy that are good for the community,” he said. “This is one of them.”