Note from Fluoride Action Network: In 1992, Hooper Bay’s water treatment equipment failed and fluoride levels were so high one man died in the nation’s first death due to fluoride poisoning.

ANCHORAGE, Alaska — Dentists say the equation is simple: less fluoride equals more tooth decay. Soda and sweets just add fuel to the fire.

It takes a lot of extra effort to brush your teeth in Hooper Bay. Since there’s no piped water here, it all starts with a ride out to the lake. If you’re lucky, the ice hole is still open.

Although there are watering points in the village like the laundromat, most families don’t trust the well water, and it’s not just because it’s yellow.

In 1992, the water treatment equipment failed and fluoride levels were so high one man died in the nation’s first death due to fluoride poisoning.

Ben Nukusuk said he remembers the incident.

“We were here at that time. All of us got sick and the kids got sick, they couldn’t stop throwing up,” Nukusuk said.

The Nukusuk family never drank well water again.

The village stopped fluoridating its well water and with good reason. An investigation showed that fluoride levels in the water system hadn’t been checked in almost two years.

That wouldn’t happen today. New state and federal standards will not permit communities to fluoridate water unless they have trained water plant operators.

But with cuts in state funding, not many villages can afford to pay people like Richard Curtis, who tests fluoride levels in Toksook Bay every day.

Toksook Bay was one of many villages that stopped fluoridating after the tragedy at Hooper Bay, but resumed a few years ago.

Before the Hooper Bay death, 130 communities fluoridated their water. In the ‘90s that number may have dropped to as low as 20. Today, it’s back up to about 35.

Every weekday morning Dr. Olivia Hougen works in a surgery room at the Bethel Hospital. Children in Bethel have so many cavities they need to go under anesthesia to have them removed.

The average cost for the dental restorations is $7,000 to 10,000 each.

Hougen also travels to Hooper Bay once a year.

“You can definitely see a difference between those children that grew up on some of that fluoride versus those that did not,” Hougen said. “Sometimes there’s a cavity in every single tooth.”

Hougen said the numbers of ear aches are also higher.

“A lot of our children have otitis media, bouts after bouts of otitis meida. They have found that after dental rehabilitation is completed, the number of ear infections that they have is definitely decreased,” Hougen said.

In villages that stopped fluoridating, the need for dental work in the operating room has also grown.

One longtime Bush dentist compared the difference between two western Alaska villages. Kotlik does not fluoridate and Emmonak does. He said 90 percent of the Head Start children in Kotlik either had treatment in the operating room or needed it. In Emmonak only 31 percent needed it.

Alaska Native Tribal Health Consortium Environmental Health Coordinator Troy Ritter said it’s easy to tell the two apart.

“When I’m in the villages I can tell the difference, just by looking at teeth,” Ritter said.

He said the incident at Hooper Bay taught a valuable lesson.

“It provided a blueprint to make sure that nothing like that ever happened again,” Ritter said.

Many communities now believe if they can’t afford meet the standards, then it’s safer not to fluoridate.

Dr. Myron Allukian was one of the early fluoride advocates. He led the push for fluoride in Boston, Massachusetts.

“Fluoridation is the most cost effective measure we have to prevent dental disease; great cost-benefits ratio. For every dollar you spend on fluoridation you get $38 back in better oral health,” Allukian said. “Before we fluoridated Boston, the average 17 year old in Boston had 17 tooth surfaces affected by tooth decay. That’s in Boston, we have three dental schools.”

Despite all the evidence, there are some communities that can afford fluoride but don’t want it in the water.

David Ottoson of Rainbow Foods played a key role in getting the Juneau assembly to pull the plug on its fluoridation policy.

“I don’t think the municipal water system is an appropriate system for delivering what essentially is a medication,” Ottoson said.

Other anti-fluoride advocates in Juneau fear fluoride may cause other health problems. Dental experts predict Juneau will come to regret taking it out of the water.

But for those who want fluoride and can’t get it through the water supply, there may be another answer.

“In 1955, in Switzerland, they began adding fluoride to table salt,” Ritter said. “Table salt has been proven to be just as effective and just as safe as water fluoridation.”

Countries like Mexico and Italy have used it and it might be the answer for many communities in Alaska that cannot afford to fluoridate.

The Food and Drug Administration has not approved fluoridated table salt, because they fear those who have fluoridated water may ingest too much fluoride.

At high levels fluoride can be toxic and discolor teeth.

Dentists say fluoride toothpastes and other products do help fight tooth decay, but don’t as long of an impact as fluoridated drinking water. A study that looked at children from 35 different villages found that those from communities with fluoridated water were five times less likely to experience tooth decay.