Fluoridated water might not be imposed on some suburban Pierce County communities, if health officials will allow them to develop alternatives.

Local leaders say they would form a multicity committee to work on ways to deliver the tooth-decay-fighting compound other than through drinking water.

The Tacoma-Pierce County Health Department staff is willing to work with cities on options such as mobile dental screening and care, teeth varnishes and sealants, and individual fluoride applications, if the health board approves, health director Dr. Federico Cruz-Uribe said.

And elected health board members, who for the second time had been poised to mandate fluoride in water supplies serving more than 5,000 customers, seem receptive to a compromise.

“It’s likely we’ll see a modified response to fluoridation,” said Tacoma City Councilman Kevin Phelps, chairman of the Tacoma-Pierce County Board of Health.

Phelps said the board knows of too many cases where a local child’s school grades drop because he or she is suffering from oral disease. He noted that Pierce County is above the national average for cavities.

Even so, he said the board could allow cities and water utilities that don’t want to fluoridate to come up with good alternatives that could be tracked for effectiveness.

City officials want the health department to take charge of identifying children in need. The cities and health department likely would share the as-yet-undetermined costs of treating them.

Elected officials from Bonney Lake, Sumner, Edgewood, Milton, Steilacoom, and representatives from Puyallup and water utilities met with health officials last week. Many urged the health department to back off forced fluoridation.

In 2002, the health board ordered water providers serving a total of 238,000 people to add fluoride. Bonney Lake, the Lakewood Water District and four water companies appealed the decision. The state Supreme Court in May said the health board lacks legal authority to enforce its mandate on public water districts.

Cruz-Uribe recently returned to the health board with a new fluoridation order. It would affect people in Puyallup, Bonney Lake, Edgewood, Sumner, Milton and Spanaway.

The mandate would exclude the Lakewood Water District, which serves 70,000 customers in Lakewood and Steilacoom. The water district is asking voters in the general election to approve or reject fluoridation.

More than 300,000 residents of Tacoma, University Place, Fircrest, Parkland, and local military bases already get fluoridated water.

During a heated board of health meeting Oct. 6, more than two dozen people spoke against the latest plan, and the board delayed a decision until Nov. 3

Kathy McVay, co-chairwoman of the health board and a Fircrest City Councilwoman, has been meeting with local elected officials this month and has committed to working with them on alternatives. She represents all cities and towns other than Tacoma on the seven-member board.

Some criticism has laced these discussions.

Sumner Mayor Barbara Skinner called the health department‚s previous process to force fluoridation “atrocious.” On the other hand, Skinner said, she and other local elected officials share blame because they failed to pay enough attention to what the health board was doing.

Edgewood Mayor Bill Evans said the health department upset a lot of people with its “dictatorial approach,” and has failed so far to give elected officials statistics on the extent of the tooth decay problem in their communities.

McVay said the department would respond to the request.

Pursuing fluoride alternatives not only would appease residents who complain about things like forced medication and loss of local control.

The cities also might save money.

Bonney Lake officials have said that installing a fluoridation system would cost $700,000 and $30,000 annually in maintenance. Sumner said it spent about $118,000 and estimated $20,000 annually in maintenance costs before it stopped fluoridation. Prevalence of cavities among children

The Tacoma-Pierce County Health Department has estimated the following prevalence of cavities, based on examinations in schools by dental hygienists. They seem to give an uneven picture of fluoride’s benefits.

Fluoridated areas Unfluoridated areas Low-income children 35 percent 50 percent (Pierce County) All children (County) 39 percent 46 percent All children (Tacoma) 59 percent N/A