Anti-fluoridation activist Paul Connett says that he can’t get anyone to debate him about fluoridation, but he got something close to a debate on Saturday.

Lora Schultz, health coordinator for Head Start in Billings, showed up at a Billings motel for Dr. Connett’s announced challenge to take on fluoridation proponents.

Ms. Schultz, a registered nurse who has been among those pushing for fluoridation in Billings, said she wasn’t there to debate, but she and the chemistry professor got into an exchange that had the heat, if not the format, of a public debate.

Dr. Connett, who teaches at St. Lawrence University in Canton, N.Y., is among the nation’s most visible opponents of fluoridation. He has challenged fluoridation supporters to public debates around the globe, sometimes leaving empty chairs on stage to symbolize their unwillingness to appear with him.

As he has elsewhere, Dr. Connett issued a public challenge to fluoridation supporters in Billings to debate him. A news conference sponsored by the Cancer Prevention Coalition to dramatize the challenge drew little attention from the press, but Ms. Schultz gamely appeared to defend the pro-fluoride position.

She said before the encounter that the American Dental Association advises against public debate with anti-fluoridation activists. Notes the ADA provided to counter anti-fluoridation arguments said that one of Dr. Connett’s lectures in February “should have been titled the shotgun approach to defeating fluoride, tell em it causes everything and maybe they will believe it causes something.”

Ms. Schultz also questioned Dr. Connett’s credentials, noting a lack of peer-reviewed scientific articles on the topic.

In opening remarks, Dr. Connett took strong exception to attacks on his background, arguing that fluoridation proponents frequently attack the messenger while refusing to examine the evidence.

“What there will be is an attempt to undermine my career without actually debating me,” he said.

Dr. Connett made no claim that he had conducted original research on the issue, but he said he had been reviewing the literature for six years – twice as long as he had spent on the research that resulted in his doctorate. As he claimed in an article in the April 10 Outpost, Dr. Connett argued that the benefits of fluoridation have been exaggerated and its health risks understated.

Accepted levels for optimal fluoridation were set decades ago, he said, but people now receive fluoride from a variety of sources, including toothpaste, fruit juices and possibly even air pollution. If anything, Americans now get too much fluoride, which has been shown to cause fluorosis, a condition that results in mottled teeth.

Fluoridation opponents argue that fluoride also has been linked to a variety of other health effects, ranging from increased hip fractures to cancer. Much of that research is either disputed or has been rejected by many in the scientific community. Dr. Connett acknowledged that some of the scientific evidence against fluoridation isn’t conclusive, but he argued that the burden of proof is on fluoridation proponents.

“There are huge red flags,” he said. “My job as a critic is to point out those red flags. … When you look at all the risks, we’d have to be damned lucky to find out that not one of these risks is valid.”

Dr. Connett argued that a more effective approach would be to increase spending on healthcare for the poor. Fluoride could be applied topically, or in bottled water that could be made available through the Women, Infants and Children program for those who need it, rather than imposing it on the entire population. Children also could fight tooth decay by consuming less sugar, he said.

“If you want to do something for poor children, get Coca-Cola machines out of the schools,” he said.

He and Ms. Schultz found at least some common ground on improved dental care. Health groups in Billings – including dentists and dental hygienists, among many others – have said they support fluoridation in large part because local dental care is inadequate.

According to information presented at a recent dental summit, the number of dentists in Billings is declining, and they donated $200,000 in dental care in 2000. Dental problems are the seventh-leading cause of emergency visits to Deaconess Hospital, and make up 18 percent of emergency department visits at St. Vincent Healthcare.

Fluoridation is inexpensive, effective and safe, proponents say. They note that placing fluoride in the water supply allows residents receive its benefits without having to alter their behavior or lifestyles.

In Missoula, where similar dental problems exist, the Preventive Oral Health Advisory Health Committee also has recommended fluoridation. But the Missoulian newspaper reported last week that the Missoula Health Board is considering such measures as reducing access to pop machines rather than taking on the politically difficult fluoridation issue.

About two-thirds of Americans drink fluoridated water, but only 22 percent of Montanans do. The Billings City Council has tentatively scheduled a public hearing on May 13 on the issue.

Some indication of how unpleasant that debate could become surfaced in Saturday’s news conference. When Ms. Schultz, speaking from the audience, cited local evidence of dental problems, Dr. Connett challenged her to provide evidence in the same sort of peer-reviewed studies that are demanded of fluoridation opponents.

When she cited support for fluoridation from dozens of federal and medical institutions, among them the U.S. surgeon general and the Centers for Disease Control, Dr. Connett demanded to know how many of those groups had independently reviewed the evidence.

“What about the pope?” he said sarcastically. “Did the pope review it, too?”

He accused proponents of a paternalistic and arrogant attitude that appeals to authority rather than to scientific inquiry.

“You argue like parrots and you defend like chickens,” he said.

“So, name-calling, huh?” Ms. Schultz responded.

Ms. Schultz said at one point that fluoridation backers don’t care to debate opponents such as Dr. Connett because the scientific issues have basically been put to rest. Dr. Connett responded heatedly, “You’re citing the propaganda machine.”

Dr. Connett also objected strongly to Ms. Schultz’s characterization of anti-fluoride research as “junk science,” a phrase that had been used by Jane McGinley of the American Dental Association during the dental summit.

“Stop trying to solve this with one-liners,” Dr. Connett said. “Look at the data.”

An audience member wanted to know why so many reputable medical groups would endorse fluoridation if significant health risks existed.

“I think it comes down to something pretty human,” Dr. Connett said, “and that’s an unwillingness to admit you’re wrong.” After years of support for fluoridation, groups such as the American Dental Association may be reluctant to acknowledge any health risks because of fears of lawsuits, he said.

Former state Rep. Brad Molnar said the whole debate may be specious since neither ordinary citizens nor members of the Billings City Council were sufficiently versed to judge the scientific evidence.

“The debate should be about how to get the purest water possible to Billings, not what the acceptable level of risk is,” he said.

Later Saturday, Dr. Connett held a public seminar on fluoridation.