For decades, New Jersey has resisted mandating fluoridation of public water supplies.

Opponents effectively battled off state bills requiring fluoridation, questioning its benefits in fighting tooth decay while raising concerns that too much fluoride could lead to health problems.

As a result, the state ranks near the very bottom in the nation in a federal ranking of public water supplies that are fluoridated.

This could change as the result of a measure requiring fluoridation that will be voted on by a state council Monday.

The Public Health Council, an advisory board for the state Department of Health and Senior Services, will consider a petition by the New Jersey Dental Association to require fluoridation of water supplies that don’t meet a recommended one part per million natural level. This standard is analogous to 1 inch out of 16 miles, the association says.

The proposal affects only investor-owned water companies, such as Aqua America, which serves part of Gloucester Township and Laurel Springs, and New Jersey-American Water Co., which serves a large share of South Jersey and is the largest water company in the state.

Municipal water departments are not covered because of concerns about creating a new expense for the state during its budget crisis, said Eric Elmore, an association spokesman. New Jersey has a requirement that the state pay for new programs it mandates local governments to implement.

“We do hope we can get all the water fluoridated at the recommended level. But we’re really focusing now on getting this done,” Elmore said.

Still, the proposal would bring fluoridated water to about 45 percent of the state, or about 4 million residents, including 2 million New Jersey-American customers. This is a significant increase from the current 15.5 percent, which ranks New Jersey at 48th in the nation.

If the council approves the petition, the state health department would hold public hearings before adopting the new regulation.

Dr. Robert Pallay, a Somerset County family physician who serves as the council’s chairman, said New Jersey ranks near the bottom for dental care, possibly because of its ranking at the bottom for fluoridation.

While Pallay would not predict how the vote will go, he said, “Obviously, I’m a physician and there are very few physicians in the country that don’t think fluoridation is a good idea.”

Some residents are furious, though. The benefits of fluoridation have been debated for years.

Some studies suggest too much fluoride can impair the thyroid, disrupt hormones, interfere with brain function, cause bone cancer, and cause fluorosis, which is a spotting of teeth.

“I’m really against it,” said Maple Shade resident Barry Dorfman. “It’s mass medication.”

Fluoride is a common element, often found in extremely small amounts in water supplies. It is also a byproduct of industrial processes that can be added to boost fluoride levels in water supplies.

The federal government says adding extremely low levels of fluoride has been proven to reduce cavities, especially in children who do not have routine access to professional dental care.

Federal studies suggest that fluoridation can reduce cavities by as much as 60 percent in baby teeth, as much as 40 percent in children age 8 to 12, and as much as 35 percent for teenagers and adults.

“I think this is coming 30 years too late,” said Dr. Steve Markus, who runs a dental practice in Haddon Heights. “We’re seeing a much higher incidence of decay than ever before.”

He believes fluoridated water will help youngsters battle the decay brought on by drinking too much soda and eating too many sweets.

But opponents say the public already gets too much fluoride in toothpaste, mouthwash, even beverages bottled in cities that have fluoridated water.

“We are exposed all over the place,” said Nancy Coleman, a Morris County resident who is president of New Jersey Citizens Opposing Forced Fluoridation.

Coleman, 58, says she was once a proponent of fluoride, even giving her children fluoride supplements when they were young.

But she says she came to realize fluoride is “an industrial grade toxin taken from phosphate fertilizer scrubber chimneys. You can’t legally dump this in any body of water, yet you can put it in drinking water.

“It’s not the lack of fluoride that’s causing a dental crisis; it’s lack of dental care,” she said.

Coleman said grass-roots campaigning by her group is one of the reasons New Jersey doesn’t fluoridate widely. Her group formed in 1956 as the result of the first state bill to require fluoridation.

Other bills have died over the years. Opponents argue the New Jersey Dental Association is trying to accomplish through a regulatory framework what it has been unable to do through legislation.

“I’d start drinking bottled water,” said Dorfman, a 51-year-old pension consultant. “I’d be forced to drink it in every restaurant I went to.”

Fluoridation of public water supplies began in 1945 in Grand Rapids, Mich., and expanded rapidly throughout the nation during the 1950s. Most major cities now fluoridate. Philadelphia has fluoridated its water since 1955.

Opponents argue fluoridation is a holdover from that era, a time when spraying of DDT was thought to be a great way to control mosquitoes and PCB-laced oil insulated electricity transformers across America.

If people want fluoride, they argue, they can get supplements. The government, they say, shouldn’t force it on the entire population.

About 2 out of 3 Americans on public supplies live in communities with fluoridated water. Minnesota leads the nation, with 98 percent of its population on public water systems receiving fluoridated water.

Last year, the Centers for Disease Control and Prevention affirmed its support for fluoridation. It says a tiny amount of fluoride in water is a cost-effective way to ward off tooth decay, particularly for lower-income people who do not have routine access to dental care.

Markus, when starting out as a dentist three decades ago, worked at a practice in Margate. He said patients from Atlantic City, which fluoridated its water, had significantly lower decay rates than those from surrounding areas that did not fluoridate.

Sweets and soda break down into acids that “demineralize” tooth enamel, making the dentin underneath susceptible to rot, he said.

“Putting fluoride in the water is a lot like putting wax on your car,” he said. “The likelihood of rust developing on your car is going to be a lot less if you keep your car clean and polished under a layer of wax.”