As the Sonoma County Board of Supervisors continues to research the idea of adding fluoride to the county’s water supply, activists are raising questions about issues of safety, effectiveness and consumer choice despite what county leaders call an “oral health crisis.”
Sparked by a 2009 report called the Sonoma Smile Survey, which found discouraging dental health statistics in Sonoma County, the Board of Supervisors is in the midst an accelerated study of community water fluoridation, which would add fluoride to tap water through the Sonoma County Water Agency.
For Supervisor David Rabbitt, who represents Petaluma, the study seemed dire. Among its findings was that 16 percent of Sonoma children have untreated tooth decay, and four percent are in urgent need because of pain or infection.
“We have an oral health crisis in the county,” he said in characterizing his reaction to the report.
“I’d like to make sure we understand that lack of dental health is a significant problem in Sonoma County,” underscored Karen Milman, the new Sonoma County Dental Health Officer. “There are significant disparities in who has dental health problems. In particular, low income (residents) and Latinos have more decay and higher needs for dental treatments.”
For county government officials, community water fluoridation is a proven solution to this problem.
“There are hundreds of millions of people receiving fluoridated water in the country,” said Rabbitt. “Water fluoridation is the most effective, least costly prevention effort with the broadest community reach.”
Community water fluoridation has been a common practice to reduce tooth decay for decades, and a standard in the state’s Health and Safety Code since the 1990s. County officials note it’s one of several programs under consideration in a unified plan to develop better dental health in Sonoma County. (Besides fluoridation, the so-called “Five Pillars of Dental Health” are improved access to dental care, community education, fluoride varnish and tooth sealants.)
In December 2014 the Board of Supervisors approved $10,000 to study engineering aspects of fluoridation, adding to the $105,000 budgeted early in 2013 to develop a full proposal. The current engineering estimate for the water fluoridation project is $12.8 million over 30 years.
But opponents of drinking water fluoridation are not backing down, even after a recent setback when Healdsburg residents voted to keep fluoridating their water in a November ballot measure. That city, which began fluoridation in 1952, is the only one in the county to do so. Nationwide, several other cities also rejected anti-fluoridation measures last November, including towns in Michigan, Kansas and Washington.
A recent draft oral health report by the county Department of Health Services found significantly lower need for dental treatment in Healdsburg than the county average among kindergartners and third graders, supporting the case for the positive effects of fluoridation.
Having lost the Healdsburg vote, fluoridation opponents are turning their attention to the county’s ongoing study of the issue, which is being conducted through a Fluoridation Advisory Committee appointed by the supervisors. The committee consists of government officials, health and dental professionals, and community and environmental voices, including some from opposing organizations. Opponents, however, have felt stymied by the three-minute limit for public comment the committee’s format allows.
A Dec. 8, 2014 letter to supervisors from the advocacy group Clean Water Sonoma-Marin calls for a public two-hour presentation at least a week before the final vote on the matter where “those opposed to fluoridation … will present their reasons for opposition.”
“We certainly listen to all public comments at the Fluoridation Advisory Committee,” said Milman, one of its 24 members. “We try to answer the questions as best we can in our processes. There’s a lot of comments that are sometimes a confusion of the science, and we try to clarify that.”
She discounts, for instance, the contention that the compound added to water for fluoridation, hexafluorosilicic acid, is a byproduct of the fertilizer industry. Although the same compound might be created in fertilizer production, its manufacture for dental fluoride is a separate process, according to some experts.
Objections to fluoridation include the possibility of fluorosis, a discoloration of teeth enamel from over-exposure to fluoride. Jim Wood, a former Healdsburg city council member, the new California Assemblyman for District 2 and a practicing dentist, dismisses that idea.
“Dental fluorosis is generally not easily visible,” he said. “I have seen it in some patients in my practice and usually only under magnification. It is minor, potentially cosmetic, but mostly inconsequential.”
Recently, opponents of fluoridation have turned to the core issue of “choice” in their arguments.
“We can choose fluoride for ourselves, in our toothpaste or from our dentists, but individual choice isn’t possible with fluoride in our water,” wrote Carol Goodwin Blick of Clean Water Sonoma-Marin in a letter to the Santa Rosa Press Democrat. She also cited a number civil rights organization that oppose fluoridation, including the Sonoma NAACP.
The American Dental Association consistently endorses water fluoridation as safe, effective and healthy. The Centers for Disease Control call it one of the greatest public health achievements of the 20th century.
“I think fluoride alone is probably not the solution,” concluded Supervisor Rabbitt. “But it’s certainly one of those pillars that is an accepted best practice.”