With a veto override during the final hours of this year’s legislative session, the Nebraska Unicameral either chose to save thousands of people’s teeth or poison them with a toxic substance, depending on what studies you believe

Legislative Bill 245 requires cities and villages with over 1,000 residents to either fluoridate their water supplies to levels recommended by Health and Human Services or to opt out of the law with a public vote before June 1, 2010. The Legislature set aside Governor Dave Heineman’s veto with a 31-4 vote, citing the need to fight tooth decay, particularly in children. Heineman called the bill an unfunded mandate, saying it could cost cities up to $5,000 per well for the proper equipment. Cities with levels of at least .7 parts per million of naturally occurring fluoride need not make any adjustments.

Chadron voted against community fluoridation in May, 1978, and the original version of LB 245 would have allowed the ordinance created from that ballot to stand, but that portion of the bill was struck down. That means Chadron will have to either comply with the fluoridation or have a public ballot on the issue to opt out once again.

Other cities in the area large enough to be affected by the law include Gordon, Rushville and Crawford. Rushville has had fluoridated water since the 1960s, and Gordon began adjusting fluoride levels in 1978.

Crawford does not fluoridate but does have naturally occurring fluoride at levels of .32 parts per million.

The Pros and Cons

The American Dentistry Association (ADA) calls fluoridation of community water supplies “the single most effective public health measure to prevent tooth decay” in its Fluoridation Facts brochure on its Web site. Likewise, the Center for Disease Control lists fluoridation as one of the 10 greatest public health achievements of the 20th Century.

Data for 2002 indicates that approximately 170 million people in the U.S. drink water treated with fluoride. The ADA contends that community fluoridation reduces dental decay by 20-40 percent.

The U.S. Public Health Service recommends fluoride levels of .7-1.2 parts per million as the optimum level to prevent tooth decay. The Nebraska Department of Health and Human Services regulations list an allowable level of fluoride at .8 to 1.5 parts per million with the optimal level at 1 to 1.3 parts per million. The regulations also state that no fluoride compound need be added to water supplies if fluoride occurs naturally at .7 parts per million.

Not everyone agrees, however, that fluoridation of community water supplies is the answer.

Dr. Arvid Carlsson of Sweden the 2000 Nobel Prize winner in physiology or medicine, objects to the practice, saying that everyone reacts differently to medication and what is beneficial for one person may be harmful for another. The Fluoride Action Network cites Carlsson as calling community fluoridation “obsolete,” saying he disagrees with the CDC that it is one of the greatest public health achievements.

Opponents point out that each person drinks a different amount of water, meaning dosage cannot be controlled, and could become toxic for someone who drinks more water. The Scientific Consensus Statement on Environmental Agents Associated with Neurodevelopment Disorders put together by the Collaborative on Health and the Environments Learning and Development Disabilities Initiative was released in February of this year. It says excessive ingestion of fluoride can decrease thyroid hormone levels and cited a Chinese study that links lower IQ levels in children with fluoridated drinking water. The main concern, the report says, is cumulative exposure and excessive ingestion from multiple sources. It concludes that the benefits of fluoridation are not clear enough to outweigh the risks of neurodevelopment and other effects.

The Environmental Protection Agency’s maximum standard for fluoride is 4 milligrams per liter, but in 2006 the National Academy of Science reviewed that standard and found it can cause health problems such as dental fluorosis and weakened bones over a lifetime of consumption. The report also pointed out that a 20-40 percent decrease translates into less than one decayed tooth surface per person. The Wall Street Journal in March 2006 said the study recommended that the EPA conduct a risk assessment to determine how much to decrease the maximum standard by.

The EPA’s Headquarters Professionals Union, made up of scientists, lawyers and other professionals, also now opposes community fluoridation.

Supporters of fluoridation say there are no generally accepted scientific studies proving a link between fluoride use and any number of health concerns. The ADA Web site lists dozens of studies that dispute the links to things such as cancer, damage to chromosomes, thyroid issues, Alzheimer’s, heart and kidney disease, central nervous system disorders and effects on intelligence.

In addition to health concerns from cumulative build-up and overdose, opponents say community fluoridation is a form of mass medication and takes away citizen’s right to consent to medical treatment. They also argue that fluoride is more beneficial when applied topically n directly to teeth n and any systemic benefits from ingesting the substance are not worth the risks. Finally, some protesters claim that to make fluoridation cost-effective, some cities get their supply in the form of hydrofluorosilicic acid, a classified hazardous waste captured in the production of phosphate fertilizer. Dr. Joseph Mercola, a family medical practitioner who founded Mercola.com, a natural health Web site, says most studies on the benefits of fluoride and its toxicity are done with pharmaceutical grade fluoride rather than the waste materials used to actually fluoridate water.

By 2004, in Nebraska the HHS Water Division had tested 607 water systems serving 81.4 percent of the 2000 Census population for fluoride, both adjusted levels and naturally occurring. Over 50 cities in the state adjusted their fluoride levels at that time, and about 30 have naturally occurring fluoride at “therapeutic levels.”

Dr. Travis Lambert, a dentist in Chadron, said the “benefits (of fluoridation) are clear-cut throughout the literature.” While fluoride is a toxic substance at certain levels, he said it’s important for people to understand that any adjustment made to the city’s water supply will remain within the guidelines for therapeutic levels. Should the city move forward with fluoridation, they will take into account the level that occurs naturally and add only enough to bring it to within optimum levels to prevent tooth decay.

Dr. Daniel Johnson, another Chadron dentist, is strongly in favor of the measure, calling fluoride “nature’s cavity fighter,” as is Dr. Terry Owen. Over the years there has been an increasing use of fluoride without widespread negative effects, Owen said.

In his practice he has seen dramatic evidence that fluoride supplements implemented with an overall improved oral hygiene program can reduce rampant decay. However, dentists do have to be aware of the fluoride level in the water supply, whether it’s naturally occurring or added, Owen said. Too much fluoride can cause problems, so dentists must be aware of how much is in the local water supply and avoid prescribing fluoride supplements if there is already an optimum level available.

Chadron has naturally occurring fluoride in its water system at levels of .44-.48 parts per million, said Steve Boeselager, Chadron’s utilities superintendent. He is currently in the process of gathering information for the city council and the general public to make a decision on what to do in regard to LB 245. That information will include cost estimates on purchasing the chemical and the injection pumps and analyzers required for water system.

Sandra Powell, Chadron’s city manager, said she hasn’t heard much talk on the fluoridation issue within the community, but says other cities like Chadron that rejected the measure in the 1970s are frustrated that they have to go through the process and expense of another ballot. Powell is fairly certain the city will bring the issue before the public in a vote before the 2010 deadline. If voters do approve fluoridation, Powell said many of the bottled water brands do not add fluoride and could serve as an alternative to those who wish to avoid the substance.

If Crawford chooses to comply with the mandate, Mayor L.J. Moloney said it will not likely begin fluoridation until 2010. Moloney said medicine and science seemed to have proven over the years that fluoride is beneficial and the issue of fluoridating water doesn’t seem to be as controversial as it once was.

“I know in the 1960s and 70s it used to be a hot-button issue, but I think those days are long gone,” he said. However, Moloney added that if there is a segment of Crawford’s population against the fluoridation, they will certainly have the right to persuade the city council to put the issue before the people for a vote.