Newburyport one of several communities where ban is discussed

BOSTON — A public health program to fight tooth decay that dates to the end of World War II is increasingly controversial, as opponents of adding fluoride to the public drinking water step up efforts to end the practice in several Massachusetts communities.

At least 140 water systems in Massachusetts, reaching more than 4 million people, add fluoride to the drinking water to fight cavities, according to the state Department of Public Health. Most have been doing so since the 1950s.

But activists in some communities are fighting to end the practice, saying it causes potential health problems and raises constitutional issues.

In Rockport, voters will decide in the next election whether to continue putting fluoride in the town’s drinking water after anti-fluoride activists secured approval from selectmen and the state Legislature to put the question on the ballot.

In Newburyport, a group of residents is pushing the city’s Board of Health to ban the use of fluoride or let voters decide in the next election.

Opponents to fluoride treatments in Gloucester, Topsfield, Cambridge and several other communities are plodding forward with similar proposals.

“Cities and towns are required to provide clean, drinkable water – not medicate people,” said Andrew Teichner, a Boxford-based activist who is involved with anti-water fluoridation campaigns in several North Shore communities.

Teichner and others opposed to fluoridation say we live with a saturation of the chemical compound in products ranging from beer and juice to prescription drugs and gasoline.

“You’re drinking and bathing in fluoridated water. It’s in your food, gas, drugs, toothpaste – everything,” he said. “It’s out of control.”

Such concerns have kept several towns in the North Shore and Merrimack Valley region — ­ including Georgetown, Merrimac and Rowley — from adding fluoride to their water.

Other communities, like Amesbury and Methuen, have opted out of the program in recent years though public referendums.

Rowley voters rejected a proposal in 2000 to begin adding fluoride for the first time in decades, and the issue hasn’t come up again since then, according to Town Administrator Deb Egan.

“As I recall, there was tremendous opposition to adding it,” she said.

A number of communities in the region get drinking water through the Massachusetts Water Resources Authority, including Marblehead and Swampscott. The authority, which provides water from the Quabbin and Wachusett reservoirs to 51 communities, adds fluoride before it pumps water to cities and towns.

Proponents of fluoridation say adding it to drinking water is a safe, effective and affordable way to improve public health – especially among low-income children without access to dental care or children whose parents who don’t stress proper nutrition and dental hygiene.

Public health officials have called fluoridation one of the 10 most successful health campaigns of the 20th century. They cite studies showing the prevalence of tooth decay among teens in the United States has declined from about 90 percent to 60 percent in the past two decades.

“The scientific evidence is overwhelming and indisputable,” said Dr. Anthony Giamberardino, a Medford dentist and president of the Massachusetts Dental Society. “It’s very clear that in communities that have fluoridated water the incidents of dental decay in children and adults has gone way down.”

He said public health officials face a battle against “misinformation” spread by the anti-fluoride movement.

“All it takes is a few very vocal individuals to sway a town board,” he said.

“The way fluoride works in the water is that it gets into teeth as they’re developing,” he said. “It makes the enamel that much harder and much more resistant to decay.”

Opponents say fluoride causes other health problems — including damage to soft tissues and bones ­– and that adding it to the drinking water violates an individual’s right to consent to medication.

“We believe that every city and town should have the right to vote on the question,” said Stephen Dean, president of the Save Our Water Committee, a statewide organization. “When you go to the dentist, you have the right not to be treated with fluoride, but cities and towns that put fluoride in the water don’t give citizens that choice.”

Most Americans drink water treated with fluoride, but adding it drinking water supplies has long been a contentious practice.

It dates to the the 1940s, when scientists discovered that people whose water supplies had higher concentrations of the naturally occurring fluoride also experienced less tooth decay.

After World War II, health officials embarked on a public campaign to add fluoride to water systems, despite fierce resistance. At one point in the ’50s, some considered such programs part of a Communist plot.

Many fluoride treatments these days come from industrial byproducts produced by aluminum companies, which sell it in liquid or powder form on the wholesale market for about $1.10 a pound. It is approved for human consumption by the Food and Drug Administration.

Concerns about the detrimental effects of over-fluoridation prompted the U.S. Centers for Disease Control and Prevention in 2011 to lower the recommended level for fluoride in water supplies to 0.7 milligrams per liter. The move was prompted, in part, by a federal study suggesting that too much fluoride was streaking some children’s teeth.

In 2006, the National Academy of Sciences recommended that the U.S. Environmental Protection Agency reduce its maximum fluoride level in drinking water to below 4 milligrams. It warned that a lifetime of drinking water with fluoride at that concentration could raise the risk of broken bones.

Dentists acknowledge that over-fluoridation is unhealthy but say the federally recommended levels are reasonable, especially given the presence of fluoride in other products.

“Too much of a good thing is bad, and that’s why they set limits,” Giamberardino said.

More than 70 percent of Americans get water from public systems that add fluoride, according to the U.S. Department of Health and Human Services.

But 200 municipalities nationwide have stopped fluoridating the water since 2008.

Most of the country’s major cities still use fluoride, but at least one, Portland, Oregon, recently voted to discontinue its use [sic, in 2013 Portland voted not to start fluoridation].

Health officials say towns and cities opting out of water fluoridation it leave a patchwork of communities where tooth decay among children is rampant.

“It’s going to take us back to the days when kids had mouthfuls of cavities,” Giamberardino said. “It’s really unfortunate.”