SALINA — When Alan and Cindy Reed started devoting their evenings and weekends to going door-to-door to talk with their Salina neighbors about an upcoming vote on water fluoridation, they considered avoiding houses with the blue “Stop Fluoride” signs.
Orthodontists Cindy and Alan Reed are working with others in Salina’s medical community to rally support for maintaining fluoride in the public water supply. Voters will decide the issue Tuesday.
The husband-and-wife orthodontist team, with 50 years combined experience, doubted they could change the minds of the people who lived there. But when Cindy started knocking on those doors, she generally found residents willing to hear her out. By the time she was done, many of the people she talked with pulled up their anti-fluoride signs.
Something struck her about some of those who didn’t.
“Of the four, two of them were smoking a cigarette while they were talking to me about fluoride being toxic, and they didn’t want anything toxic,” Cindy said.
Since 1968, Salina has fluoridated its drinking water to the level recommended by the federal Centers for Disease Control and Prevention to fight tooth decay. Yet the issue is now pitting neighbor against neighbor in this central Kansas city of almost 50,000 people.
A dentist’s office on a busy Salina street displayed three of the yellow pro-fluoride signs, possibly in rebuttal to the chiropractor next door who had one of the blue anti-fluoride signs in front of his office.
The majority of Salina’s medical community is rallying in support of maintaining fluoride in the public water supply, with 21 doctors and 39 dentists joining a pro-fluoride coalition.
Under the direction of Allison Lesko, president of the Salina Dental Society, the group has canvassed houses, distributed signs and even put together television commercials touting the benefits of fluoridated water.
Doctors and dentists in Salina, along with other fluoridation advocates, say removing fluoride from public water will lead to dental issues, especially among lower-income residents who have trouble affording dental care.
The coalition is taking nothing for granted with Tuesday’s vote.
Kevin Robertson, executive director of the Kansas Dental Society, said that’s the right approach.
A fluoridation effort in Wichita — currently one of the country’s largest cities without fluoridated water — failed decisively in 2012, emboldening anti-fluoride activists throughout the state.
Robertson said efforts to pull fluoride from the water of Wellington and Parsons were kept off the ballot this year. But if the Salina measure passes, fluoride opponents are likely to continue their efforts.
“Unfortunately, at this moment the momentum seems to be kind of an anti-fluoride momentum,” Robertson said.
That momentum extends across the state line into Missouri, where the Kansas City suburb Independence and its population of 120,000 remain without fluoridated water.
Former City Councilman Jason White and other public health advocates have wanted to change that for years, dating back to a heated 2003 debate when a deadlocked City Council — including White — failed to muster the votes to put the issue on the November ballot.
White said the positive effect of fluoridation would be particularly strong in his community because the Independence Water Department also serves customers in surrounding areas, including the large suburbs of Lee’s Summit and Blue Springs.
White said fluoridation advocates have discussed making another push multiple times since 2003, including as recently as 18 months ago.
But they backed away, in part because of the 2012 Wichita vote and a similar result in May 2013 when voters in Portland, Ore., rejected adding fluoride to their water supply.
“We did not see the ability to get it over the goal line,” White said.
The history
The origins of water fluoridation date back to the early 1900s, when a pair of dental researchers tried to determine what was causing a condition known as “Colorado Brown Stain.”
Longtime residents of Colorado Springs had brown, mottled teeth. The teeth were unattractive, but the dentists also noticed that they were far less prone to cavities. They eventually determined that the local water supply had high levels of naturally occurring fluoride — far higher than the tightly controlled levels found today in municipal drinking water.
Dr. H. Trendley Dean, head of the National Institutes of Health’s dental hygiene unit, later determined that at a level of about 1 part per million, fluoridated water could have the teeth-strengthening properties of the Colorado Springs water, with almost none of the visual defects, which by then were called “dental fluorosis.”
In 1945, Grand Rapids, Mich., became the first city to fluoridate its water at that level, and Dean and his NIH team began monitoring 30,000 Grand Rapids schoolchildren. Within 11 years, their tooth decay rate had dropped 60 percent.
Since then, controlled water fluoridation within a recommended range of 0.7 to 1.2 parts per million has been widely adopted and tooth decay rates have fallen dramatically across the country.
The CDC lists fluoridated water as one of the top 10 public health achievements of the 20th century and has a website that allows users to learn if the water in their community is fluoridated and at what level.
There has been extensive research on the safety and efficacy of water fluoridation. The Journal of the American Dental Association lists more than 1,000 articles on the subject. The Environmental Protection Agency has, since 1974, studied fluoride levels in water as part of its mandate under the Clean Water Act. That research has found that fluoride is safe to consume in drinking water at levels more than four times those used today.
The National Research Council issued reports on fluoridation in 1951, 1977, 1993, 2006 and 2007. Based on those data reviews and others, the CDC has determined that community water fluoridation “is a safe, effective, and inexpensive method to reduce tooth decay” and recommended it be continued in communities that currently fluoridate and extended to those that do not.
Despite the research findings, opposition to fluoridation continues across the country.
The resistance
In Kansas, that resistance lately has been headlined by Wichita resident and former Boeing employee Mark Gietzen, who gained political capital picketing an abortion clinic in that city for decades.
Courtesy Mark Gietzen.
Mark Gietzen was part of the 2012 drive to keep fluoride out of Wichita’s water.
Gietzen was part of the 2012 drive to keep fluoride out of Wichita’s water. He also convinced his state representative, Republican Steve Brunk, to introduce an anti-fluoride bill in the Legislature. Brunk soon distanced himself from the bill, and it died in committee.
The bill would have required municipalities to warn residents that fluoridated water lowers intelligence. The handful of studies that Gietzen points to as evidence for the warning are based on data collected mainly from areas of China with naturally occurring levels of fluoride far higher than those in U.S. drinking water.
“This is a science question and a science issue,” Gietzen said. “It should not even be a political issue, but it unfortunately is.”
In Salina, Gietzen’s cause has been championed by Lou Tryon, a retired elementary school teacher who now tutors children.
“I noticed they had some dental fluorosis on their teeth and they were coming to me for a little help and having trouble trying to learn, so I put two and two together,” Tryon said in a phone interview.
Tryon later said she was not sure if fluoride was “the total cause” of the children’s academic difficulties, but she believes the chemical is linked to learning disorders like ADD and ADHD.
She called fluoride a “hazardous waste from the phosphate fertilizer company” and linked drinking water fluoridation to a secret agreement between former Alcoa attorney Oscar Ewing and then-president Harry Truman.
Opponents of fluoridation of Salina’s public water supply say it is more harmful than helpful to residents’ health.
When asked why she believed water fluoridation was harmful in the face of so much evidence to the contrary, Tyron said, “I think the science is actually on our side.”
Tryon cited research by Albert Schatz, the scientist who co-discovered the antibiotic streptomycin, as an example. However, Schatz’s hypothesis about fluoride’s carcinogenic properties was discredited by National Institutes of Health researchers in 1973.
Tryon also named Charles Gordon Heyd, vice president of the American Medical Association in 1936-37, and Environmental Protection Agency researcher William Marcus as fluoride skeptics who have informed her position.
Still, the bulk of the scientific and medical community say that fluoride at the recommended levels in drinking water has been proven safe for human consumption and effective in fighting tooth decay.
Supporters of drinking water fluoridation include the CDC, American Dental Association, American Public Health Association and American Academy of Pediatrics.
The consequences
The safety of water fluoridation has been studied repeatedly. A 2010 study initiated by the U.S. Department of Health and Human Services actually resulted in a recommendation that the level of fluoride in drinking water should be lowered slightly due to increased amounts of fluoride in toothpaste and mouthwash.
The CDC adjusted its recommendation accordingly and began recommending that families use low-fluoride bottled water sometimes for baby formula because infants can proportionally ingest higher amounts of fluoride.
The scientists said the previous recommendations were still safe, but other increasing sources of fluoride could be contributing to mild dental fluorosis, a cosmetic condition. Unlike the “Colorado Brown Stain,” lesser degrees of fluorosis generally manifest themselves as white spots on teeth.
Within Salina’s medical community, those spots are the only commonly recognized consequence of maintaining the current level of fluoride in the drinking water.
Lesko, who has been practicing in Salina for seven years, said the fluorosis she’s seen is so slight it’s almost imperceptible to the naked eye.
“I’ve never seen a severe case outside of a book,” she said.
Lesko said no Salina medical doctor had come forward with information about patients with other conditions related to fluoride intake.
“Nothing has come through where they’ve seen any ill effects here in Salina,” Lesko said. “Obviously we have 69, going on 70, years of research showing the levels of fluoridation in public water are safe.”
Rob Freelove, a doctor at the Salina Family Health Care Center, said he does not know of any patients diagnosed with a fluoride-related illness in his 14 years of practicing there.
Freelove treats low-income residents at his medical clinic. He said their dental care needs are underserved even more than their medical care needs, and losing fluoridated water would only widen that gap.
“If we take it out, we’re doing our community a huge disservice,” Freelove said. “I’ve seen what it looks like now, and I dread that it could be a lot worse.”
John Adams has practiced dentistry in Salina since 1975. When he started, Adams said dentists from nearby communities without fluoridated water referred some of their young patients to him.
“I saw so many kids that needed full-mouth rehabilitation, I would put five or six kids in the hospital about every third or fourth Friday,” Adams said. “I rarely, if ever, saw kids even close to that destruction in the Salina area.”
Lesko said a study done in Antigo, Wis., after it stopped fluoridating its water shows what could happen in Salina. The town added fluoride to its water in 1949 and then stopped in 1960. In five years, tooth decay increased by 200 percent among the town’s second-graders, by 70 percent in its fourth-graders and by 91 percent in its sixth-graders.
Antigo resumed adding fluoride to its drinking water in 1965.
“Within the first five years, you’re going to see this increase in cavities,” Lesko said.
Today’s residents of Salina have more access to other sources of fluoride than the residents of 1960s Antigo did. But Adams said the effects of surface treatments found in toothpaste and mouthwashes weren’t as deep or lasting.
“You can put fluoride on the outside of teeth, and it helps for six to eight months,” Adams said. “But if you drink fluoridated water from the time you’re 1 to the time you’re about 8, you will have a lifetime benefit from that.”
Lesko said drinking fluoridated water may be all that many low-income residents with less access to dental care do on a regular basis to protect their teeth.
Removing fluoride from the water will hurt that segment of the population the most, she said, and the costs will be spread throughout the community because Kansas Medicaid covers most children’s dental services.
Salina spends about $10,000 to $15,000 per year fluoridating the water. A cost analysis done by the Children’s Dental Health Project for Oral Health Kansas estimated that within a few years, dental treatment costs in Salina would rise by $580,000 per year if the city discontinues fluoridation. The share of that related to care for Medicaid patients would be borne by the public.
“It’s the taxpayers that are going to have to fund restorations or replacements for those children,” Lesko said.
The politics
The battle over fluoride in Salina is intense.
Cindy and Alan Reed, the orthodontists, say they are knocking on doors because they want to spare Salina children from the consequences they know will result from a vote to de-fluoridate the city’s water supply. They’ve read the research.
“We’re capable of looking at how the studies were done, what variables were controlled, what variables were manipulated, if any, how the variables were measured, if other factors were either controlled or accounted for,” Alan Reed said. “Looking at things like what kind of sample size was used. All those things are very important to generating good evidence or data so there is evidence.”
Campaigning on the other side of the question are people like Sheryl Musfelt.
“I personally think we have been duped and fluoride has never been safe,” Musfelt said. “And my right to choose what I ingest was taken from me in 1968.”
On Tuesday the voters of Salina will decide.
Drive down Ohio Street, a main drag lined with ranch-style homes and strip malls, and the yellow “Keep Fluoride” signs with gleaming smiles seem to have the upper hand. Drive up Broadway Boulevard, which runs parallel about a mile-and-a-half west of Ohio Street, and the blue “Stop Fluoride” signs with their skull-and-crossbones warning prevail.
Alan Reed said members of his family have received calls from as far away as Washington state from anti-fluoride activists urging them to vote for the ballot measure. Wichita’s anti-fluoride movement has been mobilized, with Gietzen and others visiting Salina and making presentations.
The push is on, but Salina’s medical professionals are pushing back. Lesko said they learned from the recent Wichita vote.
“We know that this is spreading,” she said. “They’re trying to start a wildfire, and so we’re out here with our firehoses and everything saying, ‘OK, if you’re going to start a wildfire, we’re more than prepared.’”
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