To fluoridate or not to fluoridate? That is the question New Jersey lawmakers are again considering as they debate whether to mandate adding fluoride to drinking-water systems across the state.
Supporters say doing so is a proven way to improve dental health, particularly for uninsured residents and low-income families who can’t afford regular dental visits or other means to obtain the tooth-protecting compound.
Opponents question the cost and other potential health impacts from too much fluoride exposure.
The issue is not a new one. American cities and water companies have been adding fluoride to drinking water since the early 1960s, and the U.S. Centers for Disease Control and Prevention has called fluoridation of drinking water “one of the 10 great public health achievements of the 20th century.”
Despite the touted dental benefits, New Jersey utilities have largely resisted fluoridating their water supplies. The Garden State ranks as the second least-fluoridated state in the nation, with only about 13 percent of its population served by water systems with fluoridated water, according to the CDC. Only Hawaii ranks lower, with 10.8 percent.
In Burlington County, only three agencies — the Mount Laurel and Willingboro municipal utilities authorities, and the Florence Water and Sewage Department — are believed to fluoridate their water.
New Jersey American Water, the county’s largest water supplier serving all or parts of 23 of its 40 towns, does not fluoridate, nor does the Evesham Municipal Utilities Authority or the Pemberton Township Water Department.
Assemblyman Herb Conaway, who for eight years has sponsored legislation requiring the fluoridation of all public water systems in New Jersey, said the failure of utilities to use the compound is senseless.
“Water fluoridation is a safe and effective way to prevent cavities in children and adults, and saves money that would otherwise be spent on dental care by families and governments,” Conaway, D-7th of Delanco, said last month after an Assembly Health Committee hearing on a fluoridation measure. “More than six decades of use, countless studies and the experience of millions of Americans tell us water fluoridation is effective in preventing cavities and is safe for children and adults.”
Conaway is chairman of the Assembly Health and Senior Services Committee as well as the only practicing physician in the state Legislature. His bill would require all public systems to be fluoridated within a year.
The measure was approved by Conaway’s committee after the Jan. 30 hearing by a vote of 9-0, with two abstentions.
Companion legislation sponsored by Sen. Joseph Vitale, D-19th of Woodbridge, was released by the Senate Health, Human Services and Senior Citizens Committee on Thursday afternoon by a vote of 6-1, with two abstentions.
Sen. Dawn Marie Addiego, R-8th of Evesham, cast the only no vote. Sens. Diane Allen, R-7th of Edgewater Park, and Samuel Thompson, R-12th of Old Bridge, abstained.
The vote followed more than two hours of testimony from supporters and opponents, who disagreed about the cost of requiring utilities to fluoridate and the potential health benefits and risks.
“This is literally one of the most critical, least expensive and most effective ways you can prevent the most common childhood disease in America,” said Jim Schulz, director of government affairs for the New Jersey Dental Association.
The association and other supporters estimate that the cost to upgrade New Jersey’s water systems for fluoridation would amount to about $1 a household.
“Its cost-effectiveness, which has been seen through three-quarters of America, speaks for itself,” Schulz said.
Utility officials contend that the capital expense would be much greater and could potentially cost in the hundreds of thousands or the millions of dollars. The cost would either have to be passed on to customers or result in the elimination or delay of critical infrastructure improvements.
“There’s no question that the intention of this is good, but there are other ways to get fluoride,” said Karen Alexander, president and CEO of the New Jersey Utilities Association.
Burlington County Freeholder Mary Ann O’Brien testified against the fluoridation bill, claiming it would give New Jersey American Water an excuse to seek more rate hikes. O’Brien said the utility is seeking a 20 percent increase from the New Jersey Board of Public Utilities to cover infrastructure improvements.
“New Jersey American Water charges more than any other utility for water, and this bill effectively orders them to charge more,” she said. “And at the risk of sounding a bit cynical, it also gives them a reason to charge more.”
O’Brien cited the Evesham MUA, which would have to build fluoridation stations at 13 of its wells. She said the cost of each station could range from $100,000 to more than $700,000, depending on whether land acquisition is required.
“Multiply those numbers by 13 and that’s the impact on Evesham and its ratepayers,” she said.
Although the Mount Laurel MUA has fluoridated its water for decades, it too could face additional capital costs if the bill is approved, MUA Director Pam Carolan said.
The bill’s mandate that all water systems be fluoridated within a year would be impossible for most utilities to comply with because they would need to obtain state Department of Environmental Protection permits, Carolan said.
“Nobody would be able to comply with that,” she said, adding that a five-year phase-in period might be possible and would permit utilities to spread the cost over five budgets.
Addiego said she voted against the measure because of the cost.
“Mass fluoridation is unwarranted and costly. Parents, not Trenton bureaucrats, should have the final decision on how our children are medicated,” she said.
Allen said she was still undecided and wanted to research the issue. She noted that New Jersey is ranked high in dental health despite its lack of fluoridation.
“It looks like it almost doesn’t matter if you’re getting fluoride or not,” she said.
Vitale, who chairs the Senate Health, Human Services and Senior Citizens Committee, countered that the state would save millions per year in the cost of dental treatments.
“Fluoridation of water is considered one of the 10 greatest public health achievements of the 20th century, yet most New Jersey residents do not benefit from this crucial health treatment option,” he said. “We must course-correct and provide all New Jerseyans, no matter their income or access to dental care, with this proven method of combating tooth decay and dental disease.”