In the 60 years since municipal authorities in many countries began fluoridating their water supplies to reduce tooth decay, to fluoridate or not has become one of the most contentious issues ever tackled at a community level, the Nelson Mail said in an editorial on Tuesday.

Although it is backed by the Ministry of Health, the New Zealand Dental Association and numerous health professionals, it has many detractors who not only disbelieve in its benefits, but also claim that it is decidedly harmful to health.

An idea of the extreme opinions it generates came only a fortnight ago in a Dunedin City Council debate on extending fluoridation to some parts of the city where it is currently not used. One councillor, talking about “men in white coats” sometimes getting things wrong, raised the spectre of thalidomide – a connection most people might struggle with – while another likened those who oppose fluoridation to “quacks and snake oil merchants”.

That council decided to do nothing for now, batting the issue back to the annual and long-term planning process, where it will probably languish. In our unfluoridated region, it isn’t even on the agenda – although it has been brought up from time to time, most recently three years ago, when the Nelson Marlborough District Health Board tried unsuccessfully to build support. Now Nelson’s dentists are at it again, suggesting that unless fluoridation is combined with an improvement in oral hygiene, children’s teeth will return to the decay levels of the 1940s.

With tooth decay already being the most common disease for children, the most common reason for them undergoing general anaesthesia and the biggest single cause of admission to Nelson Hospital, the suggestion that the problem is worsening should cause considerable concern. However, any council that tries to push through a fluoridation programme is bound to start a war.

This does not mean that the dentists and health officials should give up. Although there have been many conflicting studies on the merits of fluoridation, the Ministry of Health has New Zealand research showing that when fluoride is added to water supplies at the optimum level of between 0.7 and 1 part per million, it reduces tooth decay by 30 to 40 percent. Only fanatical anti-fluoride campaigners will dispute that, just as pro-fluoride lobbyists cannot deny that when the level rises too high, it causes staining and pitting of teeth. The bigger side of the argument is around whether or not the benefits are outweighed by the risks, and that is where a sober, balanced debate is necessary.

Our councils have plenty to do and they can, of course, argue that families who want their children to benefit from fluoridation can bring that about themselves through the use of fluoride toothpaste and tablets. Many do – and they are likely to be the same families who take heed of warnings about the destructive effects of sugary drinks and other dietary traps.

The difficulty is in reaching the families who don’t do any of those things and whose children end up hospitalised with rotten teeth and in the running for dentures when they grow up. Fluoridated water reaches everyone who drinks the town supply. That is both its greatest benefit and, in the eyes of its detractors, its biggest failing. For the sake of the region’s children, councils should not duck from looking at it again – hopefully without being subjected to hyperbole from either side.

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