The backdrop for Pierce County’s opening debate over fluoridated water was a movie screen filled with images of young mouths riddled with rotten teeth.

“These are all children from Pierce County,” said Dr. Rebecca Sullivan, standing in front of a photo featuring six baby teeth blackened or eaten away by decay. “A lot of these kids exist in our county. They are suffering, and they deserve our help.”

Sullivan, of the Tacoma/Pierce County Health Department, presented her slide show Wednesday to the local board of health. The department is urging the board to require fluoridation of all large water systems in Pierce County to combat what health officials say is a growing epidemic of tooth decay.

About 57 percent of Pierce County’s residents live in areas with unfluoridated water, including Lakewood, Spanaway, Parkland, Edgewood, Milton and Puyallup. Residents of Tacoma, University Place, Fircrest and the local military bases are the only ones currently receiving fluoridated water.

Nearly 60 percent of schoolchildren surveyed by county dental hygienists had tooth decay, Sullivan said. Poor children are up to three times more likely to have rotten teeth than their wealthier classmates, she said.

“It has definitely reached a crisis stage,” she said.

But Sullivan was followed by about a dozen people mostly opposed to fluoridation – particularly if enacted without a public vote.

“There is no question that fluoride is toxic,” said Ursula Hall, a naturopathic physician from Lakewood. “When fluoride is added to drinking water, you medicate the whole population.”

Lynne Campbell, executive director of Oregon Citizens for Safe Drinking Water, said many newer studies question fluoride’s effectiveness.

“Cavity rates in industrialized nations have declined across the board, whether they’ve been fluoridated or not,” she told the board.

Health department Director Federico Cruz-Uribe is spearheading the drive for fluoridation, arguing that the health board has the legal power to require it without putting the issue to a public vote. Cruz-Uribe proposes mandatory fluoridation for all water systems serving more than 5,000 people.

The health board took no action at Wednesday’s meeting. Cruz-Uribe gave board members copies of a draft resolution, which they will discuss – and possibly vote on – at their next meeting, April 3.

The health department also plans to hold several public meetings on the issue this month, Cruz-Uribe said.

Representing an association of water utilities that would be required to install costly fluoridation equipment, Randy Black of the Lakewood Water District said most water managers think communities should decide for themselves whether they want fluoride in their water and whether they’re willing to pay for it.

For Lakewood alone, fluoridation could cost up to $800,000, he said.

Jeff Johnson, manager of Spanaway Water Co., said he would have to raise his customers’ water rates 80 percent to cover the cost of fluoridation.

Black also asked the board to compare the cost of fluoridation to other methods of decay prevention, such as providing fluoride drops or tablets to high-risk children.

R.C. “Skip” McConkey, who serves on an advisory board to the state Department of Ecology, said fluoride might be harmful to salmon. More than 90 percent of the fluoride added to county water will eventually wind up in effluent discharged to Puget Sound, he pointed out.

University Place dentist Rhonda Savage countered that the Pacific Ocean contains a higher level of fluoride than would be added to local drinking water.

“We have over 50 years of research proving that fluoridation is safe and effective,” Savage told the board.