Barker Hamill’s children take fluoride pills every other day. The reason: Morrisville, Pa., where they live, does not have fluoridated water. ”Our pediatrician recommended taking them,” Mr. Hamill. ”There’s no lack of evidence that it helps to prevent tooth decay.”
Mr. Hamill is not just any proponent of fluoridation. He is also chief of the bureau of safe drinking water in the New Jersey Department of Environmental Protection, the agency that tests for proper levels of fluoride in drinking water.
About 62 percent of Americans using public water supply systems receive fluoridated water, according to a study conducted in 1992 by the Centers for Disease Control and Prevention.
But in New Jersey only 17 percent of the residents were found to be receiving fluoridated water, ranking the state 46th, according to the study. Since then, the amount has risen to 19.5 percent, the State Department of Health says.
Although numerous studies have concluded that adding a proper level of fluoride to water is a safe and cost-effective way of stopping tooth decay — the average cost is estimated at about 50 cents a year per person — not everyone agrees.
Indeed, 54 years after Grand Rapids, Mich., became the first city in the United States to fluoridate its public water supply, there is still fervent opposition by critics who say that fluoridation does more harm than good, causing such serious diseases as Alzheimer’s, cancer and osteoporosis.
There have been thousands of studies on fluoride, with proponents and opponents using studies to bolster their sides.
Dr. Scott M. Presson of the Centers for Disease Control and Prevention said two major studies were made on the effects of fluoride in drinking water: ”Review of Fluoride Benefits and Risks” by the Public Health Service in 1991 and ”Health Effects of Ingested Fluoride” by the National Research Council in 1993.
”The conclusion of both these reports was that water fluoridation is safe and effective at the levels recommended by the Public Health Service and that there was no evidence of harmful health effects,” Dr. Presson said.
Fluoride can be found naturally in most water. But it can be toxic in high concentrations; overexposure can cause a condition called dental fluorosis, a discoloring of teeth in children under 6.
California, which was ranked 47th, passed legislation in 1995 mandating fluoridation in communities of more than 25,000 people, despite strong opposition because of health concerns. It is one of 11 states to require fluoridation, according to Dr. Michael Easley, an associate professor in the School of Dental Medicine at the State University of New York at Buffalo and director of the National Center for Fluoridation Policy and Research.
New Jersey is not one of them. Nonetheless, the state health department does support fluoridation, said a spokesman, Thomas Breslin.
The water systems in the state that are fluoridated are situated primarily in the central and southern parts of the state, Mr. Hamill said. Three providers with the most customers that fluoridate are Elizabethtown Water Company in Mercer, Middlesex and Somerset Counties, the New Jersey-American Water Company in Monmouth County and the city of Trenton.
As to why the areas are clustered this way, Mr. Hamill replied, ”My guess is that it happened mostly because they were closer to Trenton, and that’s where the health department put their efforts.”
Whatever the case, Mr. Easley says that like some other states, New Jersey has not been particularly aggressive in promoting fluoridation.
”New Jersey doesn’t have a state dental health director,” he said, ”and it doesn’t have a focused dental health program.”
Marc R. Millstein, director of dental health for the New Jersey Dental Association, said his organization has pushed for mandatory fluoridation but to no avail. ”It’s a very political issue,” Mr. Millstein said. ”There are times when the association has tried to get legislation, and members of the public tried to fluoridate communities but it brings out a vocal anti-fluoridation group of individuals.”
New Jersey Citizens Opposing Forced Fluoridation is one such group. Its president, Nancy Browne Coleman, says her group takes credit for having prompted such towns as Pequannock, South Orange and East Hanover to reject fluoridation in recent years.
”The purpose is to educate the public about the whole picture of fluoridation,” said Ms. Coleman. ”It’s slightly less toxic than arsenic and more toxic than lead and is very corrosive. It can leach lead and aluminum from pipes and plumbling. It corrodes equipment and causes water main breaks.”
Like other opponents, Ms. Coleman contends that there is no need for fluoridation because the chemical can be found in products like soda and beer that are manufactured in areas that allow fluoridation, and that people who want it can get it through toothpaste or fluoride supplements.
But Dr. John Stamm, dean of the school of dentistry at the University of North Carolina in Chapel Hill who is a spokesman for the American Dental Association on the subject, said many disadvantaged children do not have ready access to fluoride supplements and may not have good dental hygiene habits.
”At the moment, fluoridation is still the most cost-effective and the most socially equitable method of preventing tooth decay,” Dr. Stamm said.
To provide fluoridation, a city need only get a permit from the Department of Environmental Protection, said Mr. Hamill.
But often a water company cannot provide fluoridation to just one town but needs the agreement of many surrounding towns whose customers it serves, said Erin Reilly, a spokeswoman for the Elizabethtown Water Company.
The Department of Health and Human Services has set a goal of getting the number of Americans who avail themselves of fluoridated water up to 75 percent by the year 2000, said Dr. Scott M. Presson, a supervisor of the center’s division of oral health, but it is still an uphill battle.
”I don’t think we will meet that goal,” Dr. Presson said.