The idea of fluoridation being added to a community’s water supply is tough for some people to swallow.

They wonder if fluoridated water is one of the reasons behind soaring cancer rates throughout the country. They speculate it may be the root of thyroid problems and rampant obesity, too.

An active legion of opponents argue that fluoride – a compound added to water to prevent dental cavities – hasn’t been proven safe. Indeed, they suggest it has has instead been shown to cause spotty teeth, weak bones and other ailments.

But supporters say water fluoridation is safe and effective in helping prevent dental problems.

After all, they say, calcium fluoride occurs naturally in soil, rocks and air. In some areas of Nebraska, particularly in the southwest, the “optimal level” (approximately 1 milligram fluoride per liter of water) naturally is part of the water supply – helping to fight tooth decay.

And in areas where there is less natural fluoride, an inexpensive fluoride compound called hydrofluorosilicic acid can be added to drinking water to achieve the same benefits.

So, which is it? Good or bad?

Since fluoridation began in the 1940s, proponents have seen fluoride as a cost-effective boost for public wellness. For opponents, it’s long been a costly form of unsafe mass medication.

The back-and-forth arguments have intensified recently, spurred by a legislative bill passed by state senators in 2008. The law requires all communities with populations over 1,000 to fluoridate their water by June 2010 unless they vote to opt out of the mandate.

Nebraska legislators passed LB245 over Gov. Dave Heineman’s veto. In his veto statement, Heineman called the bill “an unfunded mandate.”

But the bill’s introducer, former state Sen. Joel Johnson of Kearney – a physician – said the state would spend less for dental Medicaid payments if more water was fluoridated, thus benefiting taxpayers and Nebraskans as a whole.

Dental care accounted for $35 million of Nebraska’s nearly $1.5 billion Medicaid program in 2008.

“I thought it was one of the least expensive ways to improve the health of a large group of Nebraskans,” Johnson said.

According to the U.S. Centers for Disease Control, for every $1 invested in fluoridation, $38 in dental expenses are saved.

But former Omaha state Sen. Don Preister, a vocal opponent in the Legislature, said the compound’s production and potential dangers are good reason to be skeptical.

In reference to the way it’s made, Preister charged that “the solution to pollution is not dilution.”

The element fluorine is a byproduct of phosphoric acid production. Fluorine is captured during production and sprayed with a spring water solution, creating hydrofluorosilicic acid, said Russell Schweiss, a spokesman for The Mosaic Co. of Plymouth, Minn., which manufactures the chemical.

While concentrated, the compound is corrosive and highly toxic, but “it’s a fallacy to say it’s toxic when diluted,” Schweiss said.

When the concentrated acid is diluted in water, it “dissociates” into the same fluoride ion that is found in water fortified by naturally occurring calcium fluoride, supporters say.

The Centers for Disease Control and the U.S. Environmental Protection Agency have both concluded the chemical dissociates successfully.

But the idea of having a “known pollutant” in the drinking water leaves a bad taste in Preister’s mouth.

“They say it’s such a small amount that it’s not harmful,” Preister said. “But there’s no way to determine how much one person consumes.”

The Rev. Arin Hess of Norfolk – who has been concerned about fluoridation for many years – said he worries that “after months and years of ingesting fluoride in small amounts, it will take its toll.”

Studies have linked high doses of fluoride to decreased IQ, increased hip fractures, thyroid problems, mental retardation, infertility, dental fluorosis (white and brown spotting on the teeth) and other health problems.

But fluoridation supporters blast the opposition’s research, calling it “junk science.”

On the other hand, some opponents allege the studies that show fluoride prevents up to 40 percent of cavities were the result of posh financial deals between benefiting parties.
“You’d just have to look at the source of research and (whom) you trust to be the expert in looking at the science,” said Jessica Meeske, a pediatric dentist in Hastings.

“You’ll find these offshoot organizations that are against (fluoridation),” she said, while the CDC, World Health Organization, American Dental Association and others support it.

Meeske noted “more than 50 years worth of solid research” and “hundreds of studies” prove fluoride is beneficial.

David O’Doherty, executive director of the Nebraska Dental Association, added this: “When you look at it as a whole, there’s really no sound evidence against (fluoride).”

But Bill Osmunson, a spokesman for the anti-fluoride coalition called the Fluoride Action Network, said dentists rarely look at studies.

Instead, they trust the word of their dental associations and university professors who are part of “incestual cesspools of infantile intellect.”

Dentists who spoke to the Daily News disagree with that contention, but Osmunson isn’t one to back down from his opinions.

“We know we are frying our brains with fluoride and fluoridated water,” said Osmunson, a dentist in the Pacific Northwest who pushed fluoridation for 25 years before jumping ship seven years ago.

Fluoridation supporters say people wouldn’t drink enough water to “fry” any brains or to cause the other health problems opponents cite.

But Osmunson and others said they believe fluoride levels in the water are not monitored as well as people are told. And the possibility of an equipment malfunction – which they fear could pump hazardous doses of the chemical into drinking water – is too dangerous to risk.

The Nebraska Health and Human Services Department’s reports of monthly fluoride samples – dating back to July 2008 – from 21 artificially fluoridated communities in Northeast Nebraska show that three had levels above the recommended high of 1.5 mg/L in the past year.

Wausa’s 1.8 mg/L – still far from a toxic dose, it should be noted – in September 2008 was the highest recorded sample.

As both sides’ supporting arguments mount, the differences of opinion stand to only become more contentious.

The case has been settled – at least technically – for the roughly 185 million people already drinking fluoridated water in the United States. That’s nearly 70 percent of public water consumers, according to the CDC.

But for Norfolk, which must soon gear up to either fluoridate or to opt out of the state mandate, the battle ensues.

* * *

Coming tomorrow: In communities across Nebraska, many are avid proponents of fluoridation, but others are not.

DENNIS MEYER/DAILY NEWS
It looks like nothing more than a crystal-clear glass of ice water, being poured by a waitress at Daddy’s Country Cafe in Neligh recently. But it’s what’s in the water — fluoride has been added in Neligh since the 1970s — that can be a source of disagreement of opinions.

Frequently asked questions:

What is fluoride?

Fluoride is a compound of the element fluorine. In the form of calcium fluoride, it exists naturally in rocks, water and air. As hydrofluorosilicic acid, it is added to drinking water to prevent dental cavities.

What does fluoride do?

Bacteria in the mouth demineralize the tooth’s enamel (the hard outer shell). Demineralization causes cavities. Proponents say fluoride helps remineralize the enamel. In addition, they say it makes it harder for bacteria to produce the acid that removes the minerals from the tooth’s surface in the first place.

How much does fluoride help?

Some studies have found fluoridated water to prevent up to 40 percent of cavities. Opponents cite other research that concludes fluoridated and non-fluoridated communities have basically similar rates of tooth decay.

Where does the fluoride added to drinking water come from?

Hydrofluorosilicic acid is a byproduct of the phosphate fertilizer industry. During production of phosphoric acid, the element fluorine is formed and later captured. It is then sprayed with a spring water solution, forming hydrofluorosilicic acid.

Has hydrofluorosilicic acid been proven safe?

The safety of the acid itself has not been tested because studies are not conducted on concentrated chemicals. However, chemicals used to fluoridate water must be certified by the National Sanitation Foundation International. Studies suggest it is safe to ingest fluoride when it is diluted in water at recommended amounts. Other research shows fluoride in high doses – above recommended amounts – causes adverse effects, such as weak bones, infertility and dental fluorosis (spotting of the teeth).