Every time Rosie Webb opened wide, her mother winced. Inside the 8-year-old’s mouth were teeth stained with brown spots, clear signs of advancing decay.
“You could see stuff,” recalls Lucille Webb, 45, a Central Point mother of two. “She had cavities.”
Daily brushing didn’t help. Neither did gargling with peroxide, a home remedy Webb hoped would avoid an expensive and uninsured visit to the dentist.
But when Rosie’s teeth started hurting her, Webb swallowed her pride and signed up for free care at the Children’s Dental Clinic of Jackson County. There, dentist Mike Boldt drilled and filled the half-dozen holes in the girl’s teeth, then shook his head over the simple solution he believes could have prevented them.
“The type of cavities she had would have been lessened by fluoride,” Boldt says. “You see a lot of good benefits to it, especially in kids.”
Like 90 percent of the nearly 100 dentists in Jackson County, Boldt wants to see fluoride added to the region’s drinking water.He backs a grass-roots movement going on now to gather more than 3,000 signatures to place the question of whether to fluoridate Medford’s Big Butte Springs water supply on a city ballot in September.
But Boldt and other medical professionals and civic leaders know that it’s a question with no easy answers.
Fluoridation debates across the country have pitted supporters who claim it’s one of the medical miracles of the 20th century against a fervent minority who believe it’s nothing less than adding poison to public water supplies.
As Jackson County takes up the issue again, supporters and critics alike are calling for thoughtful discussion of a compelling community health issue.
“The risks have to be weighed with the benefits,” Roseburg dentist J. Lee Sharp told a recent meeting of the pro-fluoride group Healthy Smiles for Jackson County. “The only way to reconcile this is through education.”
Michael Framson, a Medford building contractor who’s been the chief critic of the local fluoridation effort, agrees.
“It is time for the community to really understand this issue,” says Framson. “If the arguments are presented in black and white, we’re missing the larger discussion.”
Consensus is a worthy goal, but those familiar with the fluoride debate wonder if that’s possible in Southern Oregon.
“Thoughtful discussion? Good luck,” says Scott Curry, a Medford-based regional engineer with the state drinking water program. “The conversations I’ve seen haven’t ever been discussions. People get so emotional so quickly about this issue.”
Lee Murdoch, a longtime Medford pediatrician who’s organizing the ballot drive, agrees.
“My concern is the hysteria,” says Murdoch.
Historically, the question of fluoridation has been a hot-button issue in the region. It’s been on the ballot here twice and failed twice, in 1956 and in 1962. In 1998, the Jackson County Public Health Advisory board broached the issue again, but rescinded it quickly after a public survey failed to show broad support and opponents responded with angry phone calls and, in some cases, dire threats.
“I think that there’s a group of people in Southern Oregon who object to putting anything in their drinking water, the pure-at-heart folks,” says Hank Collins, Jackson County’s director of health and human services.
Even if a new fluoride initiative makes it to a ballot, backers will have to overcome a deep sense of public mistrust, Curry predicts.
“If I had to hazard a guess, I’d say it’s because of skepticism toward chemicals and toward the government,” he says. “I’d say it was headed for a defeat.”In an atmosphere of emotionalism, arguments for and against fluoridation have become deeply entrenched during the past 60 years or so.
Proponents, backed by groups such as the American Dental Association, the American Medical Association and the U.S. Centers for Disease Control and Prevention, point to what they say is more than a half-century of documented evidence that adding low levels of fluoride to public drinking water is a safe, cost-effective way to reduce cavities by up to 60 percent in baby teeth and up to 35 percent in permanent teeth.
“It’s clear to the people who see kids with holes in their teeth,” says Lance West, a Medford orthodontist. “It’s not even questioned.”
Opponents, which include several national advocacy groups and the Lake Oswego-based Oregon Citizens for Safe Drinking Water, counter that studies on fluoride’s safety and usefulness were conducted too long ago and in the absence of what would now be regarded as rigorous research methods.
“The best and longest study of fluoride shows a dearth of evidence,” says Framson, a self-styled expert who has spent about six years studying the issue. “Endorsements were used in lieu of good science.”
Backers claim that the benefits, though widespread, are especially notable among people with limited access to dental care, either because of poverty, lack of education, or both, adds Collins, the public health director. Local dentists figure that 80 percent of tooth decay occurs in 20 percent of the population.
“It’s the most prevalent public health problem in the community,” says Collins. The need for a universal agent against decay is even more necessary now, he argues, following recent state cuts that eliminated dental benefits to some 21,000 poor adults and children enrolled in the Oregon Health Plan in Jackson County.
Opponents like Framson argue that adding fluoride to the water does nothing to address the root causes of poverty, ignorance and poor dental care. Instead, it subjects the majority of the public to “universal medication” for the benefit of a minority, he says.
That’s not necessary, he says, especially in an era when fluoride is readily available in toothpastes, dental rinses and even in enriched food. Some Wal-Mart stores stock “baby water,” which has fluoride added.
“There is a glut of fluoride; you cannot escape it almost,” Framson contends.
Excess fluoride has the potential for some health risk, both sides say. Too much fluoride ingested when teeth are forming can cause “dental fluorosis,” a cosmetic condition that creates discoloration on teeth ranging from white spots to brown stains and pitted enamel. People who ingest very high concentrations of fluoride for very long periods of time can also develop a rare, painful, crippling condition called “skeletal fluorosis.”
To Framson, that’s more evidence that fluoride is a poison to be avoided, or, at the very least, studied further. He regards the chemical as a toxin.
“What I’m asking is for people to make sure the arguments are so compelling that we would add a substance to our water whose toxicity is somewhere between lead and arsenic,” he says.
But Sharp, the Roseburg dentist who has become an expert on fluoride, says fear about excess fluoride ingestion or fluoride poisoning is “blown out of proportion.”
“The benefits so outweigh the risks that it’s not even worth calling it a risk,” he says.
Both supporters and critics say the issue comes down to a shared public decision. Sharp, who argued the anti-fluoride position in a dentists’ debate recently, says he came to the conclusion that there are no valid scientific arguments against the practice.
“The only valid opposition to fluoridation is choice,” he says. “So choose. Don’t drink it. For yourself, don’t drink the water. Go buy some instead. But choose to provide a dental benefit for children who don’t have that choice.”
The issue, indeed, is choice, Framson says. But he believes people who want more fluoride for themselves or their children should choose to get it somewhere other than the public water system.
“If I vote for this, I’m voting for you to take this drug,” he says. “I’m voting for your children to take this drug.”
In the end, if the initiative makes the ballot, Medford voters have between now and September to decide, carefully and thoughtfully, what their final choice will be.