Dr. Anthony DiNapoli says he has little trouble identifying whether his new patients grew up outside Lancaster when he peers into their mouths.
“You weren’t born here, were you?” he sometimes asks those whose mouths are free of dental work.
Too often, DiNapoli said, fillings riddle the teeth of Lancaster natives, a telltale sign of a lack of fluoride. Lancaster is one of about 20 Ohio cities that have too little fluoride in their water.
There are other culprits in tooth decay, DiNapoli said, among them genetics, diet and oral health-care habits. But fluoridated water is an important piece of the puzzle, he said.
“In a community where there’s no fluoride and access to care is difficult in general, I think that’s a perfect recipe for disease and decay — and it’s totally preventable,” said DiNapoli, noting that he sees fewer patients with tooth decay at his Columbus office.
The Centers for Disease Control and Prevention deem the fluoridation of municipal water one of public health’s 10 greatest achievements of the 20th century. It’s been shown to prevent cavities, as well as the spread of dental caries, an infectious disease in which acid produced by bacteria dissolves the hard surfaces of teeth and, left untreated, can cause tooth loss and infections.
The Ohio General Assembly in 1969 passed a law requiring the fluoridation of water supplies that serve at least 5,000 people. But municipalities had the choice to opt out of the new law via referendum, and 30 did so.Lancaster was among them. In 2004, its city council formally reiterated the decision not to add fluoride to the water.
Today, nine of 10 Ohioans rely on a community water system. Of those 10.4 million people, 92 percent have adequate fluoridation in their water supply, defined as 0.8 to 1.3 parts of fluoride per million parts of water. The remaining 8 percent or so live in villages and mobile-home parks that are exempt from the law, or in 22 larger communities that remain exempt via referendum. The largest of those is Springfield (population 60,608), followed by Mansfield (47,821) and Lancaster (38,780).
Several state institutions use water systems that have inadequate fluoride, The Dispatch found. The Ohio Department of Rehabilitation and Correction, for example, houses prisoners in three prisons where the water has too little fluoride: Lebanon Correctional Institution in Warren County, Ross Correctional Institution in Ross County and Southeastern Correctional Institution in Fairfield County.
The Ohio Environmental Protection Agency has not required the prisons to fluoridate their water primarily because children benefit the most from fluoridation, agency spokeswoman Linda Fee Oros said. “The prison population is adults.”
Because the state law mandating minimum fluoridation in water gives communities the right to seek exemption through a referendum, Ohio EPA officials traditionally have interpreted the law’s intended target as municipalities. Prisons can’t seek redress through a referendum.
A prison spokesman noted that inmates can receive annual cleanings by dental hygienists. During such cleanings, he said, teeth are polished with a paste that has a high concentration of fluoride. All available toothpastes in inmates’ commissaries also contain fluoride.
While there are no Ohio-specific studies, those in other states have shown that less money is spent on dental care in communities that fluoridate their water, said Colleen Wulf, community preventive-services coordinator with the Ohio Department of Health’s oral-health section.
“Iodine is added to salt. Chlorine is added to water to prevent bacterial proliferation,” Wulf said. “Fluoridation is just one other public-health program that is shown to benefit the public at an incredibly low cost.”
In communities of more than 20,000 people, it costs about 50 cents per person to fluoridate the water annually, according to CDC research. For every dollar invested in fluoride, about $38 is saved in dental treatment costs, the CDC estimates.
The city of Delaware, for example, spends about $850 per month to add fluoride to its municipal water supply, said Brad Stanton, the city’s public-utilities director. Delaware had been exempt from state law because of a referendum, but it opted to begin treating its water with fluoride in 2000.
The 55-gallon blue drums of fluoride that the city uses were meant as a temporary arrangement, and a permanent system will be part of a $32 million water-plant expansion that’s currently under way. The fluoride system itself will cost $25,000.
Dr. Robert Green said he thinks he’s seeing fewer cases of “multiple caries” in young patients at his dental practice just outside Delaware.
“I think it’s been a positive for the oral health of the community,” said Green, who has practiced dentistry for 23 years.
Opposition to water fluoridation often is rooted in skepticism of the government, as well as concerns that fluoridation is toxic, can cause cancer and can lower children’s IQ’s.
But the opposition largely seems to have subsided in Delaware, said Tom Homan, the city’s manager.
“Had it not been making a difference, there would have been questions about the treatment itself, but there’s been none of that,” Homan said. “I think it has proven to be beneficial.”
See graphic in article for Ohio Communities with “Deficient Fluoride Levels”
Other articles in this series
– Many in Appalachia suffer dental woes that start early and last a lifetime
– Dental issues have big effects on poor kids
– Emergency medicine: HPV alters oral-cancer expectations
– Experts say not every dental patient needs annual X-rays
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