Rifle city officials who already had their hands full trying to control costs on a $28 million water treatment plant project were confronted with another complication earlier this year when asked to make the plant capable of adding fluoride to protect teeth.

The City Council deferred action on the request from area health professionals and decided to study the cost involved and the level of natural fluoride already in the water. Council members also talked about possibly putting the question to voters, given the polarity of opinions that exists when it comes to fluoridating water.

“I think they’re struggling with the fact that it seems to be a 50-50 division when you talk to people on whether they want it or not,” said City Manager Matt Sturgeon, who is waiting to see what new direction he may receive following an upcoming election in which five council seats are in play.

He said Rifle stopped fluoridating in 2005 in what he believes was a cost-cutting move after equipment broke.

Rifle is just one of a number of water system operators who have been grappling with the fluoridation issue in recent years.

The Snowmass Water & Sanitation District board decided this year to stop fluoridating, ending a practice dating back to 1982. The action was triggered in part when the U.S. Public Health Service revised its recommended standard for water fluoridation because of concerns over the potential for overexposure to fluoride (see related story). The water district since has agreed to reconsider the decision at the request of health officials, representatives of the town of Snowmass Village and others.

“There have also been a lot of people who have been supportive of us getting rid of fluoride,” said district Manager Kit Hamby. “There have been some reports out about problems with fluoride. There’s also just this issue of personal choice. Some people just don’t want fluoride added to their water.”

‘A POLARIZING ISSUE’

A dental professional asked the New Castle Town Council earlier this year to begin fluoridating the town’s water, a request the town hasn’t acted on. Last year the Project 7 Water Authority, which supplies water to an area including the communities of Montrose, Olathe and Delta, stopped adding fluoride to its water because of a quality-control concern related to fluoride supply sources in China. The decision has drawn both support and opposition.

“I think it’s a polarizing issue. I get that,” said John Harris, Montrose’s public works director and a member of the water authority board.

His personal preference would be to consider resuming fluoridating if the supply concern is resolved, but he said if it comes to another board vote, he’d likely vote the way the majority of city residents want, and most of the people he has heard from don’t want fluoridation.

Palisade ceased fluoridating its water in 2012, drawing concern from some retired dentists at the time, and it has stuck by that decision. The town has some naturally occurring fluoride in its water, but not enough to make the Colorado Department of Public Health and Environment’s list of water systems with what it considers to be optimal levels of fluoride for dental health.

Town Administrator Rich Sales said there are a lot of things that can be added to water, such as vitamins.

“We don’t do that either,” he said. “We really feel the science shows that fluoride is best used as a mouthwash, toothpaste, those kinds of things.”

But Dr. Katya Mauritson, a dentist and director of the public health department’s Oral Health Unit, said a topical fluoride effect from toothpaste lasts 20 or 30 minutes.

“That’s why we recommend fluoridated water, to provide much more consistent protection across the day and night as well,” she said.

While fluoride is seen as beneficial to developing young teeth, it helps adult teeth as well, and Mauritson said fluoridation is important to an aging population, particularly because many may lose dental insurance when they retire. She sees fluoridation as a universal preventive measure, including for those who can’t afford to go to a dentist.

“It really is good for everybody,” she said.

While communities that have been reconsidering their practice of fluoridation have been drawing considerable attention, Mauritson said the trend since 2000 has been toward increased fluoridation, with 50 million more Americans having access to fluoridated water since then.

“I think the science has convinced thought leaders, decision-makers to protect their populations,” she said.

DENVER DECISION DUE

Denver Water, which as the state’s largest water provider serves more than 1 million people, fluoridates its water based on recommendations of health experts, spokeswoman Stacy Chesney said. But this summer its board agreed to review its policy and the latest information from fluoridation advocates and opponents, in part because of pressure from a group called We Are Change Colorado. The board is scheduled to decide on the issue Wednesday.

Chesney said Denver Water has received nearly 1,200 comments, from as far away as New Zealand, with 1,078 opposed to fluoridation, and 663 of those submitting their comments on postcards created by We Are Change Colorado. Every public health agency in Denver Water’s service area urged it to continue fluoridating water.

“It would be a major victory if they ruled in our favor, and certainly a sign of things to come in other major cities across the United States,” said Lisa Brumfeld, state coordinator for the Fluoride Action Network.

She said everyone should have the option to use fluoride to treat their teeth if they choose, through toothpaste or other means. But she objects to people not having a choice in the matter, and says much of the world doesn’t fluoridate its water.

Brumfeld became involved in the fluoride issue after hearing about Cathy Justus, a Pagosa Springs rancher who has said scientific testing proved she had horses and dogs die from fluoride toxicity, and called for the Pagosa Area Water and Sanitation District to stop fluoridating its supply.

“This got me very concerned about the fact that we are promoting this nationally as a good idea to put into our water system,” Brumfeld said.

The Pagosa Springs district no longer fluoridates its water.

Mauritson said she doesn’t know why the animals had the problems Justus reported, but other research shows no ill health effects to animals exposed to water fluoridation at recommended levels.

As for other countries, she said a lot do fluoridate, but in some places water fluoridation is difficult because water systems draw from so many aquifers that it becomes too costly. She said some countries instead use fluoridated milk or salt.

As for the supply issues cited by the Project 7 district, she said the Environmental Protection Agency sets strict guidelines for suppliers. Hamby said supply hadn’t been a problem for the Snowmass district, and suppliers are subject to American Water Works Association standards.

‘MASS MEDICATION’

In New Castle, Town Councilor Frank Breslin has been vocal in his opposition to water fluoridation. He notes that toothpaste tubes contain a recommendation to call a poison center if more than a small amount is swallowed.

Breslin said his children grew up with New Castle’s nonfluoridated water and didn’t get cavities. He said some parents give their children sodas and fruit juices to drink, overexposing them to cavity-causing sugar and underexposing them to the fluoridated tap water intended to help them. Meanwhile, families that rely exclusively on fluoridated tap water “are taking in the poisons that are inherent in fluoride,” he said.

“I consider it a mass medication of the public without their consent,” Breslin said of fluoridation.

Mauritson believes science is on the side of fluoridation, with thousands of studies supporting its safety and value when used at recommended levels.

Kelly Keeffe is a dental hygienist and the regional oral health consultant for the nonprofit Aspen to Parachute Dental Health Alliance, which endeavors to improve access to dental care. She works with children in numerous communities and said she sees firsthand the benefits of fluoridation.

“I see a dramatic difference (in tooth condition) between kids who have grown up with fluoridated water and kids who haven’t,” she said.

CLEAR BENEFITS

Andrew Gall, a Grand Junction dentist, says he saw a much higher rate of tooth decay among patients when he used to work in Leadville, where water isn’t fluoridated.

“It’s a night-and-day difference,” he said.

Grand Junction, the Ute Water Conservancy District and the Clifton Water District all fluoridate their water.

“More than 60 years of credible scientific evidence has consistently indicated that fluoridation of community water supplies is safe,” the three have said in a joint statement in which they warn against being misled by unaccredited studies.

Gall said fluoride can be toxic “like anything else” at extremely high doses. But he thinks fluoridation has proven its safety and effectiveness in dramatically improving dental health among millions of people since its introduction.

“You can look at huge volumes of people and the amount of reduced decay of the current population of people versus to prior to fluoride (use in water),” he said.

Gall sees lots of patients who have no fillings.

“Sixty years ago, that just wasn’t heard of — just didn’t happen,” Gall said.