It seems to be getting worse: Too many people in Spokane and North Idaho have rotten teeth.

The problem is replete with long-term health consequences and alive with a brisk game of blame. Kids drink too much soda. There aren’t enough dentists. Parents don’t take their children in for checkups. Dental visits are too expensive. People don’t brush their teeth.

The medical establishment says there’s one change communities could make to begin turning around the dismal state of the region’s oral health – water fluoridation.

Yet fluoride is a third rail of local politics. A small, intensely focused group of anti-fluoride activists has waged aggressive campaigns for years to keep Spokane’s water untreated.

Several show up at every board meeting of the Spokane Regional Health District, decrying fluoride as a sinister chemical additive.

Health District board Chairman David Crump shows respect to the speakers yet keeps a keen eye on the clock to ensure they don’t abuse their time allotment.

They cite personal experiences and studies downloaded from the Internet.

Opposition to fluoride ranges from things as simple as allergies to complex conspiracies tied to the Manhattan Project, the U.S. government World War II program that produced the atomic bomb.

Some opponents label fluoride a toxic byproduct of fertilizer and metal manufacturing. Others reject compulsory medication through fluoridation, saying it impedes free choice.

Many dentists and public health advocates are frustrated by such claims, saying the lack of fluoridation in Spokane and Coeur d’Alene discriminates against the poor, especially children whose parents don’t encourage good dental hygiene.

But the health board doesn’t have the authority to mandate fluoridation.

Washington laws vest water fluoridation authority with water districts, not local health boards. It’s a law that was reaffirmed in a state attorney general’s opinion written in March.

Without such power, the local health board tabled a motion brought by County Commissioner Todd Mielke in 2005 calling for water fluoridation studies. Fluoridation hasn’t come up as an agenda item for health board discussion since, said Health District spokeswoman Julie Graham.

The last time the board listened to a formal report on water fluoridation was April 22, 2004.

According to minutes of that meeting, Ida Ovicek, supervisor of the health district’s oral health program, explained how fluoride fights tooth decay.

She dismissed claims of fluoride allergies, citing studies by the Amercian Academy of Allergy, National Academy of Sciences and World Health Organization.

And she said water fluoridation is the single most effective public health measure to prevent dental decay. It helps people of all ages, regardless of their wealth and access to dental care.

That’s significant to Spokane, where dental decay is evident in many second- and third-graders.

Ovicek said last week she could share public data about the status of oral health in Spokane, but she declined to express views about water fluoridation.

“I’m sorry I can’t give a statement on that,” she said, explaining what she called a verbal directive from the health board to stay mum on the issue. “It’s not allowed.”

That’s why an epidemiologist at the health district created a stir during a June meeting when he strode to the podium at the end of the public comment portion of the health board meeting and expressed dismay that the board regularly listens to several citizens criticize fluoridation, oftentimes misinterpreting scientific studies or using questionable or inaccurate information that wouldn’t withstand the rigors of peer review.

He expressed concern that the board didn’t solicit scientific information that would refute the anti-fluoride claims and said it was time the board brought water fluoridation back as an issue for community discussion.

The federal Centers for Disease Control and Prevention credits water fluoridation for the big drop in tooth decay and huge improvements in the nation’s oral health. It’s among the 10 greatest public health achievements of the 20th century. That’s high praise, putting fluoridation alongside the likes of seat belts, vaccines and smoking-cessation programs.

“The history of water fluoridation is a classic example of clinical observation leading to epidemiologic investigation and community-based public health intervention,” the CDC wrote.

Meanwhile, the oral health numbers worsen locally, especially among children living in poor families.

The Spokane health district reports that from 2000 to 2005, the proportion of children throughout the county with dental decay rose from 49 percent to 62 percent.

North Idaho has many of the same oral health problems as Spokane. To fight them, the Panhandle Health District funds a fluoride rinse program that so far this year has reached 8,500 children from poor families in eight school districts.

Now the district is purchasing portable equipment that will enable dental workers to give at least 600 children in five North Idaho counties sealants on permanent molars to combat tooth decay.

Those eligible have no affordable access to dental care.

Water fluoridation is spotty across the Inland Northwest. Pullman fluoridates, as do Cheney and Fairchild Air Force Base. In Washington, about 3.5 million, or 62 percent, of state residents drink fluoridated water.

Seattle voted to fluoridate its water 40 years ago.

The numbers are lower in Idaho, where about 31 percent of the people drink fluoridated water. In this region, Lewiston, Bonner’s Ferry and Sandpoint fluoridate water, according to the Idaho Department of Environmental Quality.

Nationwide, about 70 percent of the nation drinks water that is either naturally rich in fluoride or has added the chemical. This includes most large and mid-sized cities – and about 18 million people in Southern California who are now drinking fluoridated water more than a decade after lawmakers there mandated the additive.

Locally, some pharmacies offer free fluoride tablets for children with a monthly prescription from a doctor. That’s an $8 to $10 giveaway prompted by the community’s refusal to fluoridate its water to improve oral health, said Geoff Tesarik, a pharmacist at Yoke’s on North Foothills. Yoke’s pharmacies are one of the chains that offer free fluoride tablets.

The pharmacy also doles out free prenatal vitamins for pregnant women with a doctor’s prescription.

“These are things that offer such great prevention for so little money,” Tesarik said.

Voters have rejected fluoridation of Spokane County’s drinking water several times. The last time fluoridation backers brought a measure to the poll was 2000.

Spokane dentist Dr. Janine Johnson is a fluoridation advocate who thinks water fluoridation should not be brought to voters but mandated by officials. It’s a public health issue that has been wrongfully ensnared in controversy, she said.

She believes water fluoridation has been defeated by the underdog political leanings of Spokane.

“That’s what is so sad,” she said. “Water fluoridation is all about helping the underdogs.”

Last spring Men’s Health magazine ranked Spokane 98th out of 100 U.S. cities for its poor oral health.

Only Lubbock, Texas, and Philadelphia fared worse.

The magazine reported that Spokane residents didn’t floss enough, visited the dentist too infrequently, had too many teeth pulled and the city doesn’t fluoridate its water.

Johnson said there are many factors that lead to tooth decay and poor oral health, but she argues that a consistent dose of fluoride, delivered through tap water, helps build better teeth from the get-go. It benefits children into adulthood and delivers a better result than higher-concentration topical treatments such as toothpaste and fluoride varnishes.