Israelis and Palestinians will live together in peace before opponents and supporters of water fluoridation agree on anything.

Advocates of water fluoridation say it is backed by an overwhelming majority of health and science professionals nationwide and is one of the cheapest, most effective public-health initiatives ever undertaken in the United States.

They say fluoride has been proven safe through 50 years of use around the world, demonstrably reduces tooth decay and at worst, if ingested in higher dosages than is recommended, can cause some staining of teeth.

Opponents say water fluoridation does not reduce tooth decay, adds to already high levels of fluoride delivered through food, beverages and the environment and makes use of a toxic waste produced by the phosphate fertilizer industry.

Anti-fluoridationists also say fluoride is linked to a host of health problems, among them cancer, bone fractures, arthritis, thyroid disease, neurological damage, learning disabilities and lower IQs in children.

The people of Billings have 10 more days to sort through the mountains of conflicting claims before voting Nov. 5 on whether the city should begin adding fluoride to the municipal water supply.

Council action

The City Council voted May 13 to add fluoride to city water, but by early August opponents of fluoridation had gathered enough petition signatures to force a public vote on the issue.

Billings voters have defeated fluoridation proposals twice before – by 3,070 votes in 1967 and by 555 votes in 1982.

Kris Decker, one of the leaders of the Billings Citizens for Safe Drinking Water, said she became involved in the anti-fluoride fight after reading in a parents magazine about the high levels of fluoride already present in some foods, particularly fruit juices.

She said she has always tried to buy healthful, organic foods for her family, and there are simply too many questions about the benefits and risks of fluoride to justify adding it to the public water supply.

“It really goes against my ethics of trying to lead a simple life, a good, clean, simple life,” she said.

Mae Woo, a retired dentist who moved to Billings 12 years ago, said the research that she has done since giving up her practice in California convinced her that fluoridation is a vast con job being foisted on the American public by government and industry.

When she attended the UCLA dental school, she said, it was made clear to students that anyone who deviated from the orthodox line and questioned the benefits of fluoridation wouldn’t be allowed to graduate.

“Unnecessary forced medication, especially with untested industrial waste, is immoral and is a disservice to our community,” she said.

Science and belief

Billings periodontist Scott Manhart, treasurer of the Fluoride Action Campaign Effort, said the debate over fluoride, from a scientific point of view, ended years ago and only lingers because diehard opponents are unaffected by facts and logic.

Manhart, who also has a degree in genetics, said he got involved in the debate over teaching creationism vs. evolutionary theory when he lived in Wisconsin, and he sees similarities between those who promote creationism and those who oppose fluoridation.

“It is a belief system,” he said. “It is not a logical, reasonable system. That’s why when they lose, they believe more strongly.”

Fluoride opponents claim that advocates are afraid to debate them, but Manhart said the debates are useless because the opposition, no matter how many times it is proven wrong, always has a fallback argument to make. By raising innumerable questions and sowing confusion, he said, opponents hope bewildered voters will take the precautionary step of turning down fluoridation.

Lora Schultz, chairwoman of the Fluoride Action Campaign Effort and a public health nurse who is the health coordinator at Head Start, said that with so much conflicting information out there, particularly on the Internet, “at some point you have to trust somebody.”

Among the groups that endorse the fluoridation of community water supplies are the American Dental Association, the U.S. Public Health Service, the American Medical Association and the World Health Organization. The Centers for Disease Control called fluoridation one of the 10 great public health achievements of the 20th century.

Although fluoridation is endorsed by an overwhelming majority of public health authorities, opponents have experts and advanced-degree holders in their corner as well. Among them is Paul Connett, Ph.D., a chemistry professor at St. Lawrence University in Canton, N.Y., who helped found the Fluoride Action Network, one of the best-known groups working to defeat fluoridation.

Connett may be the most tireless anti-fluoridation crusader in the country, and he is the author of “50 Reasons to Oppose Fluoridation,” available at the www.fluoridealert.org Web site.

Other prominent opponents include Hardy Limebeck, head of Preventive Dentistry at the University of Toronto, and J. William Hirzy, former head of the union representing workers at EPA headquarters in Washington, D.C. Opponents also cite the backing of 13-Nobel Prize-winning scientists, including the 2000 laureate in medicine.

The recent campaign to add fluoride to city water supplies grew out of a Billings “dental summit” last year. The summit was called to look for solutions to a growing shortage of dentists and increasing use of hospital emergency rooms for dental care by low-income residents.

Water fluoridation was one of several possible solutions to emerge from the summit and a follow-up meeting. Among other proposals, health-care advocates are working on legislative changes to allow retired dentists to offer free services to the poor.

Manhart said all of the other solutions hinge on fluoridation – the cheapest, easiest way to improve dental health, particularly among the poor.

“If you don’t do this, all those other things have trouble getting a grip,” he said.
Waste or byproduct?

None of that convinces opponents like Woo. Of the many reasons to oppose fluoride, she said, probably the most important is that cities don’t lace their water supplies with “pharmaceutical-grade fluoride,” but rather with hazardous chemicals recovered from smokestack scrubbers of the phosphate fertilizer industry.

It would be illegal simply to dump the waste in rivers, she said, but somehow it is all right to do so after it has been ingested by human beings. Woo said fluoridation is a scheme by the fertilizer industry, backed by the government, to dispose of a waste product that contains lead, arsenic and other hazardous chemicals.

Woo said she also believes the conclusion of an article in the Winter 1997-98 issue of the periodical Earth Island Journal, which said the U.S. government began promoting water fluoridation after World War II because it had to get rid of tons of fluoride, which supposedly was a key chemical in the production of the atomic bomb.

Carl Christensen, director of the Billings Public Utilities Department, said he didn’t know how you could buy fluoride in a “pure form.” It is usually added to water supplies in the form of sodium fluoride, a powder, or fluorosilicic acid, a liquid. Of the two, he said, the acid is far safer because it is delivered and used in a closed system and workers never come into contact with it, unlike the powder. Both forms are dangerous in their concentrated state.

And though both are derivatives of the phosphate industry, Mike Rubich, head of water production for the city, said it is a misnomer to call them waste products. Rather, he said, they are one of the stream of byproducts that are sold by the fertilizer industry, gypsum being another.

Fluoride is naturally present in most drinking water. Levels in the Yellowstone River, the source of city water, average 0.4 parts per million. Under a fluoridation program, that level would be increased to what is considered the optimal level, 0.7 to 1.2 parts per million.
Rubich said the source of the fluoride would have no bearing on the purity of city water.

Fluorosilicic acid does contain trace amounts of arsenic and lead, he said, but in such minute quantities as to be virtually undetectable.

Every chemical added to city water – including chlorine, polyaluminum hydroxychloride and caustic soda – has to be certified by the National Sanitation Foundation, he said, and water quality standards are set by the Environmental Protection Agency. No matter what is put in the water, he said, it can’t be delivered to consumers without being certified free of harmful levels of chemicals.

In the case of arsenic, Rubich said, the EPA now sets the limit at 50 parts per billion. That will change to 10 ppb in 2006, he said, but the city is already voluntarily keeping levels below that. With or without adding fluoride, the level of arsenic and other contaminants will remain the same, he said.

“That’s the only point that can be made,” Rubich said. Talk of fluoride somehow leading to a dangerous supply of water “plays to people’s fears and it plays to people’s ignorance,” he said.

Tooth decay

Opponents of fluoridation also say that large-scale tests show no difference in tooth decay between fluoridated and unfluoridated areas. They say Europe is 98 percent unfluoridated and has the same rates of tooth decay as the United States, where two-thirds of the country is fluoridated.

Schultz said opponents are playing loose with the facts. Although it is true that only parts of Ireland and England fluoridate public water supplies, most European countries add fluoride to salt as an alternative, she said.

The ADA, in its publication “Fluoridation Facts,” said the scarcity of unified municipal water systems in Europe, combined with water-rights disputes in some cases dating back centuries, persuaded most countries to add fluoride to salt instead. Countries that do so include Switzerland, France, Spain and Germany. Countries that rely on widespread water fluoridation include Australia, Brazil, Canada, Chile, New Zealand, Israel, Colombia and Costa Rica.

The ADA says the benefits of fluoridation are unarguable. In 1993, the ADA said, the results of 113 studies in 23 countries were analyzed. The most frequently reported decay reductions observed were 40 to 49 percent for primary or baby teeth and 50 to 59 percent for permanent or adult teeth.

Medical problems

Woo and other opponents claim that fluoride can lead to various forms of cancer, hip fractures and other medical problems. When she was a dentist, Woo said, she saw the effects of fluorosis, or the mottling and pitting of teeth, on her patients.

“If it can do this to teeth I can see, what can it do to organs and bones I can’t see?” she said.

The ADA, in its publication, said: “No charge against the benefits and safety of fluoridation has ever been substantiated by generally accepted scientific knowledge. After 50 years of research and practical experience, the preponderance of scientific evidence indicates that fluoridation of community water supplies is both safe and effective.”

The ADA also quoted the American Cancer Society, which stated, “Scientific studies show no connection between cancer rates in humans and adding fluoride to drinking water.”

Manhart said previous studies of fluoride showed there was no effect, good or bad, on the risk of hip fracture. But new studies, still incomplete, suggest that sustained-release fluoride might have “amazing” benefits in preventing osteoporosis, he said.

Unregulated sources

Another point often raised by opponents is that people in unfluoridated communites are already receiving more than the targeted dosages of fluoride because it is present in so many foods and beverages, mainly because so many of them are produced in cities with fluoridated water.

They say studies have shown especially elevated levels of fluoride in fruit juices – up to 6.80 parts per million for one brand of white grape juice – and in soft drinks and cereals.

Kris Decker, one of the local opponents, said that is her main concern.

“How are we supposed to know how much fluoride our kids are getting if we have absolutely no way to control it?” she said.

The ADA discounts such fears, saying studies have shown “that little or no change in food fluoride content has occurred as a result of the fluoridation of U.S. water supplies.” Although some products, including sardines and brewed teas, may contain fluoride concentrations of 1 ppm to 6 ppm, the ADA says, a 1990 review of literature “identified no significant increases in concentrations of fluoride in food associated with water fluoridation.”

Opponents say that doesn’t tell the whole story because fluoride is heavily used in the production of pesticides, which are sprayed on fruits and vegetables. The ADA, however, said that while fluoride compounds were once commonly used in pesticides, they are rarely used nowadays, having been replaced by more effective compounds.

Fluorosis

The closest the two sides come to common ground is on the subject of fluorosis. They don’t come very close, however. Opponents say fluorosis is the permanent discoloration, scarring and weakening of children’s teeth and is a visible sign of fluoride poisoning.

The ADA describes fluorosis as a “change in the appearance of teeth” that can be prevented by closely monitoring the amount of fluoride products, mainly toothpaste, used by children. A National Institute of Dental Research study in 1986-87 showed that dental fluorosis was present in 22.3 percent of the children examined, according to the ADA.

Seventeen percent of the total number of children examined had very mild fluorosis, 4 percent had mild fluorosis, 1 percent had moderate fluorosis and 0.3 percent had severe fluorosis.

According to the ADA, very mild to mild fluorosis has no effect on tooth function and might even make tooth enamel more resistant to decay. These levels of fluorosis often cannot be detected except by trained specialists, the ADA says.

In addition, the ADA says, “Most investigators regard even the more advanced forms of dental fluorosis as a cosmetic effect rather than a functional adverse effect.”

Anti-establishment view

Sarah Rollins, another active opponent of fluoridation in Billings, said she suspects that the medical industry is much less unified on the issue than is generally let on, but doctors and dentists are afraid to take on the establishment. Among people practicing alternative medicine, including chiropractors and naturopaths, there is much less support for fluoridation, she said.

In any case, she said, the government has no business forcing medication on its citizens.

“That’s socialistic medicine,” she said. “That’s not why we live in America.”

Rollins said the ADA is an industry group, and dentistry is a business. She said the ADA supports fluoridation because it will convince people that they don’t need to brush their teeth or eat proper foods, thus leading to further tooth decay.

“I make decisions according to my life and what I know,” Rollins said. “And I’m not going to let anyone tell me what I’m going to do for my health.”