Albany is the largest municipality in the state without fluoridation; nearly three-quarters of New Yorkers drink water that has fluoride added.

Previous efforts to establish community fluoridation — which experts say is among the most cost-effective and equitable ways to prevent dental disease — provoked backlash from anti-fluoride activists and divided public officials, some of whom felt protective over local water sources and believed the drinking water additive to be unnecessary, unpopular and potentially toxic.

County Health Commissioner Dr. Elizabeth Whalen and Albany Councilman Tom Hoey are leading the latest charge, and say they have corralled the support of a broad coalition of experts, dental providers, policymakers and community groups.

“It is something that public health advocates have continuously been advocating for. But unfortunately, it tends to be something that we need political volition to make happen,” Whalen said in an interview. “I think that everything is on the right track; the importance of making this decision locally cannot be overstated.”

Hoey, who plans to introduce legislation Monday, said nine of 15 council members have already signed onto the proposal, but he anticipates a battle ahead.

“My goal is to get everybody on the council to sponsor it,” Hoey said. “If we have full local support, when the outsiders come in, at least we can say, look, we know our communities, we know our world better than somebody from the outside and we’re looking out for people in our area.”

While adding fluoride to drinking water has long been seen as a simple, cost-effective way to prevent tooth decay, New York’s patchy fluoridation map has hardly budged in nearly 70 years.

The state ranks 31st in the U.S. when it comes to community fluoridation. About 71 percent of New Yorkers had access to fluoridated drinking water in 2021, according to the U.S. Centers for Disease Control and Prevention. That figure has declined from 2000, when 75 percent of New Yorkers were accessing fluoridated drinking water.

Albany’s resistance to fluoride

Grand Rapids, Michigan was the first U.S. city to fluoridate its public water supply in 1945. About five years later, when schoolchildren there were found to have fewer cavities than others in surrounding communities, other cities began fluoridating their water, according to the CDC.

Albany has not used fluoride in large part due to opposition from its former mayors. Fears around community fluoridation date back to the Cold War, with opponents alleging fluoridation initiatives were part of a communist plot, carried health risks or infringed on civil liberties.

Albany Mayor Erastus Corning II famously opposed the drinking water additive, describing community fluoridation as “un-American.”

After a 1955 study in Newburgh found that community fluoridation dramatically limited tooth decay in the city, Corning declared, according to Times Union past reports, “Albany has the finest water in the state, if not the entire nation … we are not going to start fooling around with it.”

Over the next few years, as the fluoride debate played out in cities across the state, Corning continued to vocalize his opposition. In 1975, when the state Legislature tried to compel Albany and other holdouts to add fluoride to the drinking water, Corning decried the concept as “forced medication.”

Corning died in 1983. The issue did not come up during the tenure of Mayor Thomas M. Whalen, the uncle of the current county health commissioner, who served the city until 1993. The city’s politically appointed Water Board, which was created in 1988, took up fluoridation again in the mid-1990s under Mayor Gerald D. Jennings.

According to Albany pediatric dentist Dr. Larry Kotlow, who was involved in previous efforts to fluoridate local waters, Jennings initially promised to back the fluoridation effort, but then worried about alienating surrounding towns like Bethlehem and Guilderland that have purchased water from the city over the years.

“I spoke to every mayor in the past 50 years, because they were all running for election. They all promised to do it and then they backed out at the last minute.” Kotlow said.

The 1994 push also had a fierce opponent in then-Common Council member Tom Nitido, who convinced his colleagues to vote against the measure, according to Times Union news reports.

Jennings, in an interview with the Times Union this past week, acknowledged concerns were raised about the ability to sell local water to neighboring municipalities, noting that the city was in compliance with state regulations.

“People talked about, ‘Well, they get it in toothpaste and they get it in mouthwash’ … it gave us flexibility that there were ways for them to fluoridate, etc., etc., you know, if they wanted to,” Jennings told the Times Union.

The city’s Water Department currently sells non-fluorinated water to the towns of Bethlehem and Guilderland, which adds its own fluoride, according to Albany Water Commissioner Joseph Coffey.

Coffey disputed the notion that fluoridation would impact the city’s contract with its southwestern suburb. The city’s 20-year purchase contract with Bethlehem is set to expire this year and the town recently upgraded its own water treatment systems so that it rarely has to rely on Albany for supplementary water.

Bethlehem Town Supervisor David VanLuven said the town does not plan to renew its contract with Albany. The town may purchase water on an emergency basis, but “that should not prevent Albany from doing with its water as it sees fit,” VanLuven said.

More recent conversations about fluoridating Albany water were put on hold after the 2016 water contamination crisis in Hoosick Falls, according to Kotlow.

National anti-fluoride groups, like the Fluoride Action Network, tend to swoop in every time a municipality tries to adjust its fluoride levels, citing anecdotal cases and studies they claim point to the chemical’s harmful effects. These studies, often misrepresented, feed public wariness about unnatural substances being added to drinking water.

Proponents note that fluoride occurs naturally in water, though usually not at levels high enough to protect teeth. All water, tap and bottled, is drawn from natural sources such as lakes, streams and springs and is heavily treated to neutralize contaminants. According to the U.S. Department of Health and Human Services, the optimal fluoride level for drinking water is 0.7 milligrams per liter.

Excessive fluoride has been known to cause dental fluorosis, a condition that changes the appearance of tooth enamel. Most dental fluorosis in the U.S. is mild, appearing as white spots on the tooth surface that may be barely noticeable and do not affect dental function. Moderate and severe cases of dental fluorosis, appearing as brown or spotted teeth, are extremely rare.

‘Equalizing’ oral health

How tap water fluoridation impacts dental health in young children in New York can be hard to quantify, as many factors contribute to tooth decay, including lack of access to preventative dental care.

Proponents of fluoridation in Albany note that low-income children, especially children of color, tend to be most affected by the absence of fluoride in drinking water. The recent closures of multiple dental clinics serving low-income children have further exacerbated the city’s oral health challenges.

At the Oct. 2 Common Council meeting, a parade of Albany dentists testified about tooth decay they routinely observe in very young children, especially those from low-income backgrounds who may not have access to regular dental visits or fluoride supplements. They framed community fluoridation as a “great equalizer,” benefiting all children regardless of race or socioeconomic status.

Rebecca Klimek, one of eight dental hygienists at Seal a Smile, a program run by Whitney Young Health that provides dental services in 65 high-needs Capital Region schools, spoke of an Albany preschooler who had decay on all 20 of his teeth and is awaiting extractions and a risky, expensive restorative surgery.

Another 3-year-old, who had two dental abscesses with active infections, was asked if she felt pain and she said no.

“So often, we see young kids with advanced dental disease who are so accustomed to dental pain that they cannot remember a time that they weren’t in it,” Klimeck said. “Sometimes, they’re too young to even have the words to articulate what they are feeling.”

Klimeck said she asked the child’s mother if the toddler ever complained or had trouble eating.

The mother responded, “I just thought she was a really picky eater. It never occurred to me that she could be in pain,” according to Klimek.

Last year, nearly 400 of 2,600 children seen by Seal a Smile staff had an urgent dental need, defined as having dental pain with swelling or other infection, or a majority of teeth showing decay.

The disparities were most conspicuous among low-income preschoolers who did not have access to fluoridated water. Last school year, 14 percent of Albany Head Start students served by Seal a Smile had an urgent dental need. In neighboring Rensselaer County, where 85 percent of residents have access to fluoridated drinking water, just 4 percent of preschoolers had an urgent dental need.

The effects of poor oral health are far-reaching for children. Dental issues impair learning and negatively impact behavioral health, nutrition and self esteem, experts said.

At a South End elementary school, the room Seal a Smile uses for services is next door to a room designated for in-school suspension, Klimek said. One day, two of three students who were serving their suspensions were enrolled in the oral health program and staff were granted permission to provide them with care.

“Both of the children who we pulled from in-school suspension had an urgent dental need; both of the children had pain and infection,” Klimek said. “Isn’t it possible that if these children had not been constantly distracted by dental pain that perhaps they would have been sitting in their classrooms learning instead?”

There is robust evidence that fluoridation also lowers Medicaid costs and reduces emergency room burden. A 2010 analysis of Medicaid claims data by the state Department of Health found that, compared with the predominantly fluoridated counties, the mean number of restorative procedures, root canals and extractions per recipient was 33.4 percent higher in less-fluoridated counties.

Melinda Clark, a pediatrician at Albany Medical Center specializing in oral health, testified about young patients she sees daily who do not have access to routine dental visits, let alone dental specialists.

“The most untreated health condition in our community is tooth decay, which is staggering in a wealthy first world country,” Clark said. “In Albany, we have two problems; we have a prevention problem and we have an access problem. We can do something about the prevention problem in short order.”

*Original full-text article online at: https://www.timesunion.com/health/article/fluoride-finally-coming-albany-water-supply-18406217.php