Like it or not, thousands of county residents will soon be drinking fluoridated water.
Beginning Nov. 5, the Metropolitan Water District of Southern California, which provides 80 percent of the water used in San Diego County, plans to begin fluoridating the treated water it sends to customers here.
That means faucets around the county will flow with water containing an odorless, tasteless additive some consider an effective way to prevent tooth decay, but others deplore as an unnecessary government intrusion and possible health risk.
Although 67 percent of Americans now receive fluoridated water, Californians – and San Diego County in particular – have resisted for more than 50 years.
Whether you’ll be on tap in November depends on where you live. Some residents will receive fully fluoridated water, some will remain fluoride-free, and for others the amount will fluctuate.
At East County’s Helix Water District, officials are bracing for questions and complaints.
“People have told me, ‘There’s no way I’m going to drink fluoridated water.’ Others say, ‘It’s about time,’ ” said board president Chuck Muse.
Fluoridation of public water systems has been controversial since 1945, when Grand Rapids, Mich., became the first U.S. city to add the chemical to its water supply.
More than 8,000 communities in the United States are fluoridating their water, according to the U.S. Surgeon General’s office.
Less than a third of Californians drink fluoridated water, the sixth-lowest rate in the nation, after Hawaii, Montana, New Jersey, Oregon and Utah. San Diego is the largest U.S. city without fluoridated water. Voters twice rejected it, in 1954 and 1968.
Supporters say the science showing fluoridation’s benefits in reducing tooth decay is solid, but some opponents blame the chemical for causing cancer, Alzheimer’s disease and kidney damage.
Opposition has sometimes been stoked by conspiracy theories, from accusations of a communist plot in the 1950s to more recent claims of a scheme by space aliens to control humans’ minds.
“There are a certain number of people who are just resistant to putting anything in the water, regardless of what that is,” said Wynne Grossman, executive director of the Oakland-based Dental Health Foundation.
In mailings about fluoridation, local water agencies are assuring customers that the chemical is beneficial for them, their children and even their pets, and won’t harm the fish in their aquarium.
“It’s going to be a huge change for the better,” said Eleanor Nadler, executive director of the San Diego Fluoridation Coalition, which is funded by the San Diego County Dental Society Foundation. “We can look forward within a few years to improved dental health for everybody.”
But Jeff Green, the San Diego-based national director of Citizens for Safe Drinking Water, which relies on private donations, said fluorosilicic acid, the chemical used to fluoridate the water, is not properly tested and contains cancer-causing elements.
“The general public is not aware that this is not the same substance that’s found in toothpaste,” Green said.
Toothpaste with fluoride contains sodium fluoride, which some small water systems use for their fluoridation. Larger systems use fluorosilicic acid because it’s a liquid and is easier to handle than sodium fluoride, a powder.
Push for fluoridation
A 1995 state law, signed by then-Gov. Pete Wilson, requires public water systems with 10,000 or more connections to fluoridate their drinking water if the money becomes available to pay for the equipment and ongoing operating costs.
Three years ago, the City of Escondido became the first water provider in the county to fluoridate. The City Council voted in 2001 to accept a $140,000 grant to pay for the process at its treatment plant.
Escondido Mayor Lori Holt Pfeiler said she became convinced that fluoridation was a simple and inexpensive way to improve health.
“I heard so much overwhelming experience from local dentists who treat children and said fluoride would make a difference,” she said.
The Metropolitan Water District provides both treated and untreated water from the Colorado River and Northern California to San Diego County water agencies. The untreated water, about 55 percent of the total the MWD delivers, will not be fluoridated, but its treated water will. Some districts add their own water from wells or reservoirs to what they get from the district.
The County Water Authority has put together a map showing where fluoridation will occur. But as recently as last week, the agency was revising it because of new construction and changes in how the water will be delivered, said Gary Eaton, director of operations for the County Water Authority.
La Mesa’s water will be fluoridated, but Poway’s won’t. Oceanside and parts of Chula Vista will get partial fluoridation. The county’s backcountry relies on groundwater and will not be fluoridated. Much of the city of San Diego won’t be fluoridated, but some neighborhoods, such as Rancho Bernardo and Skyline, will get an optimal level. Other neighborhoods, including La Jolla and Encanto, will get varying levels.
“We’re still uncertain where it’s going to go ultimately because of the size of our system,” said Jim Fisher, deputy director of San Diego’s water operations. “What neighborhoods will be getting fluoridation will depend on what’s happening in the system. It even varies by the season.”
The question of who will and will not receive fluoridated water presents a predicament for dentists, who prescribe supplements for children needing additional fluoride because of inadequate dental hygiene or poor nutrition.
Although dentists stress the importance of fluoride to prevent tooth decay, consuming too much can cause dental fluorosis, a mottling or staining of the teeth, in young children whose teeth are still forming.
The American Dental Association recommends that fluoride-free water be used for infants under a year old who are drinking formula. The occasional use of fluoridated water for formula will not discolor teeth, the ADA says.
Local dentists are being advised not to prescribe fluoride supplements to young patients for a year while officials test water around the county to determine fluoride levels, said Dr. Lester Machado, president-elect of the San Diego County Dental Society.
Machado said he hopes fluoridation can be expanded to other parts of the county, particularly low-income areas.
“The kids who need it the most are the kids who don’t have access to other dental care,” he said.
Pros and cons
Proponents of fluoridation, including the American Dental Association and the U.S. Centers for Disease Control and Prevention, say it’s one of the greatest public health achievements of the 20th century.
The ADA says every dollar spent on fluoridation saves $38 in dental health care costs, and that fluoridated water reduces tooth decay by 20 percent to 40 percent, even now when fluoride is widely available from other sources such as toothpaste and mouthwash.
Dr. David Kennedy, a retired San Diego dentist who opposes fluoridation, disputes those studies. He cites other studies – hotly contested by proponents – showing the dangers of fluoridation.
“Do you think it’s appropriate for a government to put a chemical in the water that causes disproportionate harm?” he asked.
Green, leader of the anti-fluoride group, said fluorosilicic acid, the chemical used to fluoridate water, has not been tested to determine its long-term effects. The chemical contains arsenic and lead, which could lead to lung or bladder cancer, he said.
Fluorosilicic acid “is a contaminated product,” Green said.
Mark Umphries, director of water quality for Helix, said the substance contains minute amounts of arsenic and lead, but meets rigorous federal safety standards. “It’s perfectly safe,” he said.
After Escondido began fluoridating in August 2004, a group of residents, backed by Green’s group, filed a lawsuit challenging the use of fluorosilicic acid. Superior Court and appeal court judges backed the city, and the state Supreme Court declined to hear an appeal by the opponents.
Green has sent letters to every city and water district in Southern California claiming they are misrepresenting information about fluoridation. The letters are a precursor to lawsuits, he said.
Process brings wariness
Although the Escondido City Council voted for fluoridation, Helix was pushed into adding the treatment because of the state law requiring larger water districts to fluoridate if the funding is offered. Helix was placed at the top of a statewide priority list because its cost per customer was the lowest.
The East County water district received a $80,600 grant from the state Department of Public Health and a $361,000 grant from the California Dental Association Foundation to install equipment and pay for the first year of treatment.
Mark Weston, Helix’s general manager, said the board will decide after a year whether to continue. “We are doing this because we are complying with the law,” he said.
Bob Cook, general manager of the Lakeside Water District, said fluoridation is unwelcome there. The district board passed a resolution opposing the process in 1995, and he says he’s not looking forward to having fluoridated water. The district will have a blend of treated water from Metropolitan and its own wells.
“I can say this with all certainty,” Cook said: “People aren’t going to like it.”
The Metropolitan Water District, which serves 2.5 million people in six Southern California counties, spent $5.5 million on fluoridation during an upgrade of its treatment plants. Its ongoing annual expense will be $2.2 million in a total budget of $1.8 billion.
Advocates of fluoridation, such as Nadler, hope bringing the treatment to San Diego County will prompt the city of San Diego to do its own fluoridation. Equipment for the process once would have cost the city $8 million.
Now city officials said San Diego’s cost could drop to less than $3 million. County Supervisor Ron Roberts wants to cover that cost with money from a tobacco tax fund.
Roberts is proposing that the county’s First 5 Commission, which he chairs, spend $5 million to fully fluoridate the cities of San Diego and Oceanside, and the Sweetwater district in South County.
“I’ve seen what happens when kids don’t get the treatment,” he said. “It makes a huge difference.”
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Fluoride is a naturally occurring chemical element and a component of normal tooth enamel that helps teeth resist decay.
More than 67 percent of Americans receive fluoridated water, a public health movement that began in the mid-1940s but has met resistance, especially in parts of the western United States.
The U.S. Public Health Service wants 75 percent of the U.S. population drinking fluoridated water by 2010.
A 1995 California state law requires public water systems with more than 10,000 connections to fluoridate drinking water if outside funding becomes available to pay for it.
The annual cost of fluoridation ranges from 50 cents per person in large communities to $3 per person in smaller communities.