This is the final installment in a four-part series focusing on oral health problems in West Virginia.

LICK CREEK — Part of Brittany Sammons’ front tooth broke off.

She isn’t sure why. A portion off the tooth just snapped off. One day it was there, a perfectly good tooth, the next day a piece of her front tooth was missing. She was 16 years old when it happened here in this hollow just outside Williamson in Mingo County.

Her mother drove her to the dentist.

“He ‘Bondoed’ her tooth back,” said Brittany’s mother, Debbie Sammons. “The dentist told us she had the softest teeth he had ever seen. He wanted to know what kind of water we used and told us to start using fluoride.”

The Sammonses drank water from a well for years, but the water was so dirty that a lawsuit was filed against a nearby coal company. The state eventually distributed $4.1 million to extend a water line out of Williamson and up the hollow, serving the Sammonses and 240 other families.

The American Dental Association and federal Centers for Disease Control and Prevention say fluoridated water plays a major role in preventing cavities and strengthening teeth. Fluoride can stop tooth decay, reducing bacteria in the mouth that produces acid.

Nearly 92 percent of West Virginia’s public water systems provide fluoridated water to customers. That’s one of the higher rates in the country.

But 20 percent of West Virginians — or about 400,000 people — live in households not connected to a public water system and use wells instead. West Virginia has the sixth-lowest percentage of people using public water in the nation.

“We’ve got a pretty good population here that doesn’t have access to fluoridated water,” said Dr. Greg Black, West Virginia’s part-time dental director. “The fluoride bonds with the teeth and makes the surface harder.”

People in rural counties are less likely to receive fluoride in their water than those in urban areas.

In Boone, Wetzel, Pendleton and Pocahontas counties, for instance, less than one of every five people are getting fluoride in their water, according to the CDC. Hardy County has no residents receiving fluoridated water.

To make matters worse, many people with homes tied to public water systems in rural areas don’t drink the water because of its poor quality.

At the other extreme, 100 percent of Kanawha and Marion county residents receive fluoridated water. Ninety-eight percent of Cabell County residents and 91 percent of Ohio County’s population have fluoride.

In 1945, Grand Rapids, Mich., was the first city to add fluoride to its public water system. Today, about 67 percent of U.S. residents on public water supplies get fluoride in their water.

The process is cheap. For less than 50 cents a year, a public water company can provide fluoridated water to customers.

Fluoridation isn’t without its critics.

Some critics allege that fluoride is useless in helping teeth. They also claim the mineral causes bone cancer, arthritis, Alzheimer’s disease and other health problems. Some wells, they note, produce naturally occurring fluoridated water. And too much fluoride can actually damage teeth.

“Poor people have less healthy teeth because they don’t have good access to dental professionals,” said Ellen Connett, a director at the Fluoride Action Network, a Canton, N.Y.-based anti-fluoride group. “The cure-all isn’t throwing a hazardous waste substance like fluoride into the water and saying, ‘This is going to help your teeth.’”

But nearly all public health groups, dentists and scientists give fluoride a strong seal of approval. The CDC has listed water fluoridation as one of the 10 greatest public health achievements of the past 100 years.

In Mingo County, where the Sammonses live, about 40 percent of people are on a public water system and receiving flouridated water.

Until Lick Creek residents hooked up to the new public waterline last March, they drank some of the dirtiest water in West Virginia.

Residents allege that Rawl Sales and Processing, a subsidiary of Massey Energy Inc., pumped coal slurry into abandoned mines, and the slurry contaminated their well water. The residents had the water tested. They say it contains more than 30 toxins.

“It’s a toxic soup,” Sammons said. “They found the water was bad. They told us, ‘Don’t drink it. Don’t bathe in it. Don’t cook with it.’”

The coal company has said that it played no role in polluting the groundwater. Nevertheless, the company provided bottled water to Lick Creek residents for months.

The Sammonses moved up Lick Creek in 1990. Not long after, they started hearing stories about people getting kidney stones and losing teeth.

“Our neighbor — he works security for the coal company — was walking through the house and his teeth were falling out,” said Debbie’s husband, Bill Sammons, a retired police officer.

The Sammonses’ well water had become so bad it could dissolve a penny, they said. It left rust stains in their sink. It gushed from the spigot nearly as black as coal. The water smelled like rotten eggs and raw sewage.

Their daughter and son continued to have problems with their teeth. Brittany had to have some pulled.

“I have a fortune in my daughter’s mouth,” Debbie Sammons said. “I have a fortune in my son’s mouth.”

Last November, the Sammonses left their house and moved into a new home next door. They bought a 1,800-gallon water tank and put it in the garage. They filled up the tank each week with fluoridated water. Billy Sammons was hauling four 400-gallon loads to the house twice a week.

Sammons and other Lick Creek residents have asked state legislators to pay for a comprehensive study of the water. They fear that they will have lasting health problems after drinking the contaminated water over many years.

Growing up, Debbie Sammons always believed that well water was better than city water. Her opinion has changed.

“I thought it was the safest water I could have, being it came from the ground,” Sammons said. “It was the water that God provided.”