First, the dread.

Then, you’re on your back in a big, padded chair, which would almost be cozy if not for the fact that there’s a hot light burning your face, your cheeks are stuffed with cotton, and a latex-gloved hand is poking around inside of your mouth.

Most likely, anyone who has been to the dentist has not placed the experience on the Top Ten List of fun things to do.

But for the 145 million Americans — two-thirds of the country — whose tap water is fluoridated, the experience could be a whole lot worse. Or so the argument goes.

For 55 years, cities and towns throughout the U.S. have added low concentrations of fluoride to drinking water to counter tooth decay.

Ten communities in New Hampshire fluoridate their drinking water. In 1955, Durham became the first community in the state to add fluoride to its public water. Hanover followed in 1958, Lancaster in 1964, Portsmouth in 1971, Concord in 1978 and Rochester in 1981. Since then, Lakeport, Lebanon, Dover and Fryeburg, Maine, which supplies water to 100 Granite State residents, have fluoridated.

Though Keene does not fluoridate its water, and has no plans to at this time, the debate has been revived locally since Manchester voters narrowly approved fluoridation last fall. Manchester is scheduled to begin fluoridating this summer.

Manchester’s decision, combined with the state’s acceptance in 1998 of $130,000 from the federal government to provide technical assistance to communities considering fluoridation, led a group of Monadnock Region citizens to form the N.H. Pure Water Coalition, a grassroots’ organization opposed to the additive.

“If the evidence on both sides were fairly out in front of the public, they would be convinced they didn’t want it,” said Gerhard Bedding, the group’s director. Like other people who oppose fluoridation, Bedding believes the ingestion of fluoride may harm bones, hinder brain development, and lead to cancer.

Bedding of Keene sent a letter in March to Keene dentists and pediatricians asking them to “take a fresh look at the ingestion of fluoride.”

Dr. Greg A. Perry, a dentist in Antrim and president of the Monadnock Dental Society, said the group supports the American Dental Association’s research on fluoridated communities.

“It is a cost-effective and safe way to reduce the rate of decay,” he said.

Jeffrey W. Rodden, a Keene dentist and secretary to the Monadnock Region Dental Association, said his sense is that most dentists in the region would agree that the 50 years of data in solid, scientific, peer-reviewed journals support fluoridation.

Rodden gives his children fluoride tablets since Keene does not fluoridate its water. “As a professional, I would like to see the water fluoridated,” he said.

The difference of opinion between Bedding, a former science writer who has been gripped by the subject, and Perry and Rodden is not unique. Ever since fluoridation was introduced in the 1950s it has been both supported and attacked — initially as a communist plot to do in Americans and now as a capitalist scheme to generate profits for the water-purification industry, at the alleged expense of Americans’ health.

On March 29, a bill that would have lowered the percentage of registered voters required to approve putting fluoridation on the ballot from 10 to 5 percent failed by voice vote in the House of Representatives. Efforts to fluoridate Nashua and Claremont were recently thwarted when 10 percent of voter signatures could not be obtained.

Yet, Keene anti-fluoridationists are on edge. For the second time in less than a year, Vermont Gov. Howard Dean, a doctor, recommended in February that Brattleboro, Vt., consider fluoridation, asserting that the community was neglecting the oral health of its lowest-income children.

Fluoride is a naturally-occurring mineral that most medical researchers believe stops cavities by bonding with the enamel and hardening the tooth surface.

The U.S. government hails fluoridation for helping the lowest-income communities that can’t afford dental care the most — at an average of 51 cents a year per person. A bill currently in the U.S. Senate would designate $25 million to promote fluoridation in small communities and on American Indian Reservations.

The established medical community overwhelmingly supports fluoridation, and some of the most influential endorsers include the American Dental Association, U.S. Public Health Service, American Medical Association and the World Health Organization.

Proponents of fluoridation point to the fact that cavities among children have been decreasing significantly. Half of today’s kids ages 5 to 17 have never had a cavity. In 1980, 63 percent of children in that age group had treated or untreated decay, compared to 72 percent in the early 1970s They say fluoridation of community water is the single most effective public health measure to prevent tooth decay and to improve oral health in a lifetime.

A study done by the Cheshire Medical Center suggests that the teeth of Keene children are as healthy as the national average.

The first of two surveys found that 160 of 385 kindergarten through third-graders — or 42 percent — had treated or untreated decay. The second found that 577 of 1,191 children — 48 percent — had treated or untreated decay. However, community health coordinator Jane Shapiro stresses that data, which was collected in 1998-1999, does not represent all children in all Keene schools. It represents children in targeted grades whose parents gave permission for dental screening.

In response to the debate over the safety of fluoridation, the National Academy of Sciences has said that evidence from more than 50 scientific studies “does not support the hypothesis of an association between fluoride exposure and increased cancer risk in humans.” And the National Cancer Institute agrees.

Still, the government concedes fluoride is not an unalloyed boon. In the mid-1990s, the Federal Center for Disease Control ordered toothpaste makers who used the substance to put a label on their tubes warning against ingesting the substance. Still a Gallup poll conducted in 1998 indicated that 70 percent of Americans believe community water should be fluoridated.

Yet despite these statistics, a growing group of skeptics — comprised of scientists, EPA professionals, dentists and community activists — insist that at best fluoridation needs more testing and at worst America has a massive public health disaster on its hands.

OPPONENTS ARGUE STUDIES RAISE QUESTIONS

People opposing fluoridation point to fewer than a dozen studies published over the last decade in peer-reviewed journals as obscure as Neurotoxicology and Teratology and as familiar as the Journal of the American Medical Association that raise questions about the effect of fluoridated water on our bones, kidneys, reproductive organs and brain development.

The studies range from evaluating the effect of aluminum-fluoride in drinking water on rat brains and kidneys, to examining the increase in hip fractures among elderly women in fluoridated communities across the United States.

The anti-fluoridationists say that these studies introduce gray areas about how fluoride interacts with other molecules in the drinking water, and how daily, systemic ingestion effects human bones and internal tissues.

Furthermore, those opposing fluoridation do not think it has led to the decline in cavities. They attribute that decline to better dental awareness, antibiotics, frequent dentist visits, food preservatives, better sanitation, better diet, chewing gum with anti-bacterial ingredients, and an overall increase of fluoride in diet.

They assert that the public gets enough fluoride from juice, food, toothpaste and — for those who can afford it — the dentist. They argue that people who want more fluoride can take it as a supplement, but there is no reason to add it the public drinking water.

Finally, they say that the additive used in fluoridation rarely comes in the form of pure sodium fluoride. More often, it is an industrial-grade fluoride, a byproduct of the phosphate fertilizer industry known as hydrofluorosilicic acid, which contains low concentrations of silica, lead, arsenic and lead, among other contaminates.

The New Hampshire Department of Health and Human Services is currently working with the Department of Environmental Services on a unique study comparing data of lead levels in children in a total of nine communities: non-fluoridated versus communities using sodium fluoride and hydrofluorosilicic acid.

“We’re looking at the kids to see for ourselves,” said state public health official Brook Dupee. “The days of the government saying this is good for you and not doing anything are over,” he said. However, Dupee added that the evidence of fluoridation’s safety is unequivocal.

Of the 10 communities in New Hampshire that fluoridate their drinking water, Concord, Dover, Portsmouth and Rochester use hydrofluorosilicic acid. Dupee said results of the study will be available by early May.

EPA UNION COMPLAINS OF A FLUORIDE COVERUP

The most public — and most controversial — denouncing of fluoridation was made by the Environmental Protection Agency union of professionals in 1997.

Supporting a bill to rescind California’s law mandating fluoridation, the union charged that the chemicals recovered from phosphate fertilizer production and used in the fluoridation process aretoxic and can leach heavy metals from plumbing into the drinking water.

“We’re using our country’s drinking water as a hazardous waste dump,” said John William (Bill) Hirzey, senior scientist in risk assessment at the EPA and member of the EPA union. Hirzey, who has been with the EPA for 19 years, estimates that the phosphate fertilizer industry profits up to $200 million annually. He says they would otherwise have to pay a hazardous waste disposal fee.

Robert J. Carton, who worked in risk assessment with the EPA from 1972 to 1992 and was one of the first people in the agency to speak out against fluoridation, says that he decided to come out against fluoridation after he says he learned that agency-set drinking water standards were faked.

Carton now works in environmental compliance for the U.S. Army. He says new studies have raised even more questions about the safety of fluoridation. “With all this accumulating information, it’s not understandable why (fluoridation) continues. It’s crazy.”

However, Dr. Michael Easley, director of the National Center for Fluoridation Policy and Research, says Hirzey and Carton are nothing more than disgruntled employees. The center was established in1996 to serve as a clearing house of information regarding the benefits of fluoridation. Easley is also a professor at the University of Buffalo State University of New York School of Dental Medicine.

“You’ve got a few loony tunes running around trying to make claims that aren’t based on science,” he said. “These people are out to lunch.

Like others who support fluoridation, Easley asserts that there is no difference in the end product of sodium fluoride and hydrofluorosilicic acid. He says that once the additive is put in water, the fluoride ions are freed up and the other parts are rendered inert.

“This is fraud being perpetrated,” he says. “Why would we be dribbling in this stuff as a way to get rid of hazardous waste?”

But Carton charges Easley and the government are trying to smear anyone opposed to fluoridation.

“It seems that what they’re involved in is public health policy, not public health,” Carton said. “They’re desperately trying not to do a study.”

Nevertheless, most people familiar with the issue would say that the anti-fluoridation movement has earned its controversial reputation. In the 1950s, many people opposing fluoridation believed that the government was trying to control the public through this form of mass medication. For obvious reasons, they were not taken seriously.

But over the years, scientists who have completed studies presenting questions about fluoridation have been treated as though they were one in the same as the fringe radicals.

MORE STUDIES NEEDED, MORE ARE EXPECTED

Paul Connett, professor of chemistry at St. Lawrence University in Canton, N.Y., condemns the lack of debate over the issue.

“Normally, with science, you can get down and have a debate,” Connett said. “The function of the ADA has been to say like a broken record that fluoridation has no health effect. It’s just like the tobacco industry, the asbestos industry and the chemical industry. They shoot down and destroy any study that says there’s a problem.

“As a cautious citizen and chemist I think we should stop fluoridation right now and then start collecting data,” he added.

Connett, who received his Ph.D in chemistry from Dartmouth College, pointed to an editorial in the Journal of the American Medical Association from 1992 that addressed two studies on hip fractures in the elderly living in fluoridated communities. It cautioned, “For now, it is premature and unwise to provoke an angry public outcry calling for an end to fluoridation programs.”

However, the editorial said, “The focus must remain a re-evaluation of water fluoridation programs as but one of several potential controllable risk factors in the pathogenisis of hip fractures in the elderly.”

Connett wonders why more data has not been gathered.

“The U.S. government has spent millions of dollars to promote fluoridation, but has never spent money to look at the bones of the American people. We should have so much data by now that we could predict how fluoridation will impact people,” he said. Connett considers the studies the ADA promotes outdated, and says much of the material the government provides on fluoridation is not based in science so much as marketing.

The EPA has at least one of its scientists researching fluoridation. Karl F. Jensen, at the EPA’s National Health and Environmental Effects Research Laboratory in North Carolina, worked on a study — known as Varner et. al., and published in “Brain Research” in April 1998 — that examined the effects of the chronic administration of sodium fluoride and aluminum fluoride on the brains of rats.

He explains that studies are expensive, difficult to set up, and rarely mirror real-world circumstances. Though Varner et. al. is often referred to by anti-fluoridationists, Jensen cautions that it did not, in fact, provide a direct link to fluoridated water harming humans.

However, it did raise questions about the way fluoride interacts with aluminum. If aluminum is present in drinking water with fluoride, it could pose a risk, Jensen said. He hopes further studies will provide those answers.

In simplified terms, our bodies are like houses with many rooms. We are programmed not to give some elements — such as aluminum — the key to the front door. However, not only does fluoride have the key to the front door, but it allows aluminum to wander through the house with it. Once in the company of fluoride, aluminum can go wherever it pleases, as the body no longer recognizes it as an intruder.

Though aluminum is not thought to trigger Alzheimer’s disease, it is known to be linked in some way.

Jensen, who has been with the EPA since 1985 and received his Ph.D in neuroscience from Purdue University in Lafayette, Ind., said he didn’t know of any other studies similar to Varner et. al. He and other researchers are currently developing a larger version of the study with the hope of gaining more insight to the questions.

“The concerns that have been raised with regard to fluoride, I as a scientist consider important to resolve,” Jensen said. “It’s the responsibility of the scientist to address public concerns. The challenge is coming up with the right experiment that is going to address these concerns.”

But Dr. John Stamm, Dean of the University of North Carolina School of Dentistry at Chapel Hill and ADA spokesman on fluoridation, says that the studies don’t add up against fluoridation.

He points out that while some have suggested a link between fluoridation and osteoporosis, others have shown that fluoride is a beneficial treatment for hip fractures.

“When all the studies are together, the results are inconclusive,” he said. “It’s true that you get a small increase in the white flecking of the enamel in some fluoridated communities. I’m not in denial about this. But you get it in non-fluoridated communities too.

“There are public health measures where the overall public good is the biggest concern,” Stamm adds. “One of the biggest benefits to water fluoridation is that the kids at the highest risk for tooth decay benefit the most.

“The issue that needs to be stressed is that water fluoridation in one part per million is altogether different than the testing that has been done with rodents,” he says. “It’s a small minority of individuals whose findings come to controversial conclusions versus an overwhelming amount of support for fluoridation.”

However, Dr. Hardy Limeback, who had taught fluoridation for many years and was often cited by Canadian health officials in support of it, publicly declared in April 1999 that he could no longer support it.

The past-president of the Canadian Association for Dental Research and head of preventive dentistry at the University of Toronto, Limeback still believes that the topical application of fluoride — from toothpaste, chewing gum or fluoride treatments — is a valuable preventative measure.

But upon researching the difference between sodium fluoride and hydrofluorosilicic acid — a byproduct of the phosphate fertilizer industry that comes as a liquid and is less expensive than the granular sodium fluoride, Limeback changed his mind.

“They’re not using a pharmaceutical grade of sodium fluoride,” he said. “They’re using a pollution grade, an industrial grade. They’re dumping toxic waste into our water in the name of preventive dentistry and I couldn’t let my name be attached to it.”

The Monadnock Region Dental Association met in early April to discuss Limeback’s decision to no longer support fluoridation, Manchester’s narrow vote to begin fluoridating this summer, and possible negative effects of fluoride.

Bedding had wanted to attend the meeting, but was not invited.

Like most local dentists, Dr. Michael J. Ledoux supports fluoridation and said that as long as the concentration level remains at one part per million, there’s no reason for concern.

“The incidents of dental decay are much lower when water is fluoridated,” he said. “That’s been proven.”