MARYVILLE – It was Supreme Court Justice Oliver Wendell Holmes who coined the term “clear and present danger” in an opinion he delivered on freedom of speech in the early part of the last century.

But nowadays, when some Blount County folks speak about their water supply, the term comes up again in a modified form.

The water’s clear, and some say it’s a present danger.

At issue is a decision by the leadership at the South Blount County Utility District to not add fluoride to the drinking water that comes from the district’s new $16 million treatment plant on Calderwood Highway.

The controversy has two aspects:

District commissioners decided to pass on a common practice that’s widely believed to have health benefits.

They made up their minds based on a recommendation from the district’s two top managers and without much input from the 13,000 ratepayers the district serves.

SBCUD officials are proud of the quality of the water it provides, noting that the system achieved a perfect score of 100 when the state of Tennessee evaluated the water a few months ago.

A water quality report issued this past summer contained a notification that fluoride would not be added to the water after July 1, and it invited its customers to attend meetings of its board of commissioners, which are the first Tuesday of each month at 9 a.m. at the district offices, 808 W. Lamar Alexander Parkway.

The meetings, though, are normally sparsely attended, officials acknowledge.

The next meeting will be Nov. 11, because the first Tuesday is Election Day.

Isom Lail, manager of the district, said he and plant manager Henry Durant made the recommendation to the board not to fluoridate the water.

Fluoridation, he said, “is not required,” and it is the organization’s goal to put “the least amount of chemicals in the water.”

The new system, he said, uses microfiltration and ultraviolet light to purify the water, and a chlorine substitute also is added to kill bacteria.

The only other requirement, Lail said, is a corrosive inhibitor to protect old galvanized pipes.

Fluoride is added to water as a public health service, not a water improvement measure.

A broad range of public health organizations offers almost universal support of fluoridation to promote dental health.

And even opponents of fluoridation agree that it has benefits for teeth, though they say the improvement comes from application of fluoride to the surface of the tooth and not from ingestion.

Supporters say ingestion of fluoride, particularly among children whose teeth are still in formative stages, improves long-term dental health.

Lail’s position, echoed by officials of at least two national antifluoridation organizations, is that fluoride should be given “by a prescription or by a professional” and accepted by choice, not without consent in the drinking water.

“We don’t want to force something on the people on the system, he said. “People aren’t educated on what fluoride does. I am personally and professionally opposed.”

What fluoride does, says Maureen Jones, a volunteer with Citizens for Safe Drinking Water, is contribute to hip fractures in the elderly.

Jones, of San Jose, Calif., cited a 1992 article in the Journal of the American Medical Association that indicated “hip fractures double for women age 75 if they drank fluoridated water for the 20-year period prior to menopause, when bone turnover is still rapidly depositing the embrittling fluoride into new bones.”

Michael Connett of Burlington, Vt., project director of Fluoride Action Network, adds that fluoride is believed to contribute to arthritis and damage brain tissue, affecting cognitive capabilities and learning.

It also may have adverse effects on the kidneys and thyroid, he said.

“We want to raise awareness about some of the health facts of fluoride exposure,” Connett said.

A policy statement on the Web site of the American Dental Association notes opponents’ objections but says, “None of these charges has ever been substantiated by generally accepted science.

“After 50 years of research and practical experience, the overwhelming weight of scientific evidence indicates that fluoridation of community water supplies is both safe and effective.”

Local dental professionals agree and are making their case to SBCUD to reverse the decision to eliminate fluoride.

Dr. John Sterret, president of the Blount County Dental Society, said in a statement issued Oct. 4 that 96 percent of Tennesseans have access to fluoridated water.

“Rates of tooth decay,” he said, “particularly in children, may be reduced by up to 70 percent in populations served by fluoridated versus non-fluoridated water.”

Drs. Tim McConnell and Otto Slater, both on the University of Tennessee faculty in the department of oral and maxillofacial surgery, are united not only in a Blount County practice but also in their support of fluoridation.

Slater, also a Blount County commissioner, said he has tried to persuade SBCUD commissioners “that the clear evidence is that fluoride is necessary.

“As medical professionals, we are obligated to work in communities to advance public health. This is clearly to the detriment of public health.”

McConnell said, “It is poor judgment to ignore science.” The board, he said, is being “resistant to education.”

Dr. Sandy Fenton, chairman of the department of pediatric dentistry and community oral health at the UT medical units in Memphis said, “Since its introduction nearly 60 years ago, fluoridation has dramatically improved the oral health of tens of millions of Americans.”

It is, he said, “the most efficient way to prevent one of the most common childhood diseases, tooth decay.”

This focuses on one of the prime points of contention between opponents and supporters of fluoridation.

Connett, of the Fluoride Action Network, says that ingested fluoride contributes to an array of health problems and argues that only topically applied fluoride – toothpaste and prescribed treatments for the exterior of the tooth – achieve the goals of dental health.

“It makes more sense to use it on an individual topical basis,” he said. “It is readily available at grocery and drug stores. You can brush your teeth with fluoride.”

The only risk is if fluoride is swallowed, he said, pointing out that toothpaste containers advise consumers: Do not swallow.

But Dr. Fenton is at the opposite end of that argument, saying that fluoride ingested by the young in the water supply is beneficial.

“When teeth are forming in the bone before erupting into the mouth,” Fenton said, “fluoride goes into the tooth,” making it “more resistant to acid attack.

“They are stronger and more resistant to decay.”

And he adds one more wrinkle to the controversy.

Most dentists, he said, monitor how much fluoride is in the water supply in their area and may prescribe a fluoride supplement if the content falls below the generally accepted optimum level of one part per million.

Such supplements are often prescribed for people who use untreated well water, for instance.

If in a dry period the South Blount system returned to temporarily buying water from another system – Alcoa, for example, where South Blount got its water before building its new plant – the sudden reintroduction of fluoride into the drinking water could result in the inadvertent overmedication of some people who take the fluoride supplements.

“Dentists expect community water to be constant” in its fluoride content, he said. If an inadvertent overmedication occurred in that scenario, Fenton said, the water provider might bear some legal liability.

Arguments that fluoridated water is harmful are, he said, “basically baloney.”

Overexposure to fluoride produces a problem known as fluorosis, which can occur in people drinking water with eight parts per million or more, according to a posting on the Web site of the Medical College of Wisconsin.

It results in thickening of bones and problems in the joints.

SBCUD gets its water from Tellico Lake, according to plant manager Durant. The raw water is as clean as some systems’ treated water.

But the new plant makes it even cleaner, he said.

“It is exceptionally clean water,” said district manager Lail.

He subscribes to the opponents’ view that fluoride’s benefits come from topical application.

“Ingesting fluoride is not a good idea,” Lail said. “It doesn’t protect against tooth decay. And if you drink a glass of water, how much time is the water in contact with the teeth?”

Both Citizens for Safe Drinking Water and the Fluoride Action Network have hailed South Blount’s decision against fluoridating.

The American Dental Association recommends fluoridation within a range of 0.7-1.2 parts per million and also points out that the U.S. Centers for Disease Control “proclaimed community water fluoridation as one of 10 great public health achievements of the 20th century.”

U.S. Surgeon General David Satcher also supports fluoridation, noting that its benefits cut across socio-economic lines, protecting everyone.

Satcher says that in addition, fluoridation is a “highly cost-effective strategy” compared to restorative dental work.

And even opponents say the financial aspect of fluoridation is not significant enough to argue over.

Jones of the safe drinking water group points to 140 communities worldwide that rejected fluoridation since 1990. None is in Tennessee.

Indeed, a survey of water providers in the Blount County area reveals that Maryville Utilities, Alcoa Utilities, Lenoir City Utilities Board, the Knoxville Utilities Board, and the Tuckaleechee Utility District all fluoridate their water and have no plans to terminate it.

Robert Wilson may be reached at 865-981-9117.