It’s been called everything from one of the top 10 public health advances in the 20th century to a toxic industrial pollutant linked to reductions in IQ and increased likelihood of hip fractures.
Now, Ithaca city residents will once again have the chance to decide for themselves whether they want lawmakers to have the ability to add fluoride to their drinking water.
Differing interpretations of scientific data and waves of political battles have contributed to the controversy in municipalities large and small for more than five decades. Ithaca is no exception.
Staunch opponents of fluoride popped up in Ithaca in the early 1950s. Their fight continues and has garnered more supporters who say they want the freedom of choice to decide whether to fluoridate their — or their children’s — teeth.
Tompkins County is one of 14 counties in New York state without any fluoride in its public water supplies.
A “yes” vote Nov. 7 to the two fluoride propositions on the ballot doesn’t mean the city government will immediately put fluoride in the water. But the vote will decide whether the city charter should be changed to give Common Council the power to fluoridate the water supply, since the city charter currently prohibits such a legislative action.
Before any laws are passed to add fluoride, council would have to hold public hearings on the topic.
And county residents serviced by the Bolton Point water system, including the towns of Dryden, Ithaca and Lansing and the villages of Cayuga Heights and Lansing, should also pay attention to the city vote. If the fluoride referendum passes, and a proposal to merge the water systems of Bolton Point, the city and Cornell University moves forward, the question of whether to fluoridate would come before all county residents since fluoride cannot be delivered to only one municipality in the system.
Officials don’t agree
Public health officials from organizations like the Centers for Disease Control and Prevention, the World Health Organization and the American Medical Association, have praised fluoridation as an inexpensive and effective way to reduce dental decay.
And though dentists prescribe fluoride supplements, rinses, gels, and even enhanced toothpastes, they say its availability out of the tap would deliver it to the mouths of babes without any extra effort on the part of parents — an issue they say limits the effectiveness of fluoridation alternatives.
“Our biggest concern is that those who would benefit most are least likely to use them, or get them, or use them properly,” said Jeffrey Lewis, president of the Tompkins County Dental Society. This month, his group of 30 dentists unanimously endorsed fluoridation for the first time in its history. “From a safety standpoint, we are better off relying on a water source than supplementary sources,” he concluded.
Many opponents of fluoridation are worried that adding it to the water would just be — plainly — too much fluoride.
Joseph Piskorowski, an Ithaca dentist, is concerned about dental fluorosis, a condition that affects children who ingest higher than optimal amounts of fluoride, causing a disruption in the enamel formation on baby teeth. He said fluorosis can be as insignificant as a little bit of whitish discoloration on the edge of a tooth, to a mouth full of brown, mottled disfigured teeth.
“The vast majority of cases are not as bad as the brown, mottled type, though I remember one of my prior child patients who was teased for having ‘poopy teeth’ and he needed $8,000 worth of dental work,” he said. “Moreover, fluorosis can also come from too much topical application of fluoride, and most often, we see that it is the children who eat the toothpaste that have more problems,” he added.
Piskorowski doesn’t take a position for or against fluoridating the water. But his concerns mirror others expressed by community members who spoke at a Tompkins County Board of Health meeting earlier this month, where that board voted 3-2 against supporting community water fluoridation.
Piskorowski also worried that fluoridating the water may not fix the problem it’s intended to address, or may not reach the right children. In this day and age, he said, children aren’t home right after school to consume most of their water from a single source, and it is often juice boxes or bottled drinks that they get on the go.
Piskorowski agrees with Tompkins County Dental Hygenist Donna Evershed, a staff member at the county health department since 1974, who said the worst cases of dental decay her department sees are in children not serviced by city water.
Evershed has seen thousands of mouths from children throughout the county in pre-kindergarten and first grade. She said the rate of dental decay in this subset of school-age children is lower in Tompkins County than the national average, “which is quite remarkable since the water isn’t fluoridated.” The rates do vary from year to year depending on the number of families using the county’s free fluoride supplement program for people who are uninsured or underinsured.
Research is ongoing
A recent, yet still unpublished, study conducted by the New York State Department of Health’s Bureau of Dental Health between 1997 and 1999, supports the theory that water fluoridation is an effective way to reduce the disparities in dental health between poor and non-poor children.
Jay Kumar, assistant director of the Bureau of Dental Health and associate professor in the State University of New York at Albany’s School of Public Health, was the lead author of this study and several others that compare communities with and without fluoridated water.
This most recent study surveyed 2,474 second-grade children in 76 randomly-selected Upstate New York schools. And it found results consistent with other national studies done by the Department of Health and Human Services.
His group found that 43 percent of children had one or more cavities. The average number of cavities per child was 3.6. Poor children, defined as those participating in the school’s free lunch program or receiving Medicaid, had an average of 4.7 cavities, while the non-poor children had an average of 3. Though Kumar’s study did not report how many of the children lived their entire lives with fluoridated water, the study did say only 30 percent of children reported regularly using fluoride supplements who are not currently living with fluoridated water.
How widespread is fluoride?
Approximately 144 million, or 56 percent, of Americans were drinking fluoridated water in 1992, the most recent federal study completed.
Worldwide, more than 360 million people live in areas with fluoridated water. Since 1992, cities like Los Angeles and Sacramento, Calif., have added the substance. Ithaca is only one of several cities and towns deciding the issue on this November’s ballot, joining large cities like San Antonio, Texas, and Spokane, Wash., as well as small towns like Brattleboro, Vt. in votes on fluoride.
Jury still out
Fluoridation opponents have brought to light questions about the risks and other effects of fluoride on the body and mind. Some studies have shown that fluoride accumulates in bone, potentially causing skeletal fluorosis, or bone decay. Other studies show fluoride accumulates in the pineal gland, which lies between the two hemispheres of the brain, interferes with enzyme and hormonal functions, and is possibly connected to an increased rate of hip fractures among the elderly.
Moreover, Paul Connett, an internationally recognized fluoridation opponent and Saint Lawrence University professor of chemistry, told a group of 75 people Tuesday night, that the precautionary principle ought to be applied. “When an act raises threats to the environment or human health, precautionary measures should be taken, even if some cause-and-effect relationships are not fully established scientifically,” he said.
Dental professionals, including Piskorowski and Evershed, acknowledge that that jury is still out on some of fluoride’s effects. “We will never get to the point in science where questions will not be raised,” Board of Health member and pediatrician Jeffrey Snedeker said at their last meeting.
“There will always be two sides of the coin, always conflicting data that must be decided on, and there is nothing that we can do with science that has no risk involved,” he added, as he cast his vote in favor of fluoridating water.