Is fluoride a tooth-and-bone-damaging water pollutant or one of the top 10 public health successes of the past century?
The answer depends on who you ask, but the question is taking on more urgency in Pennsylvania, now.
Few communities in Bucks and Montgomery counties receive fluoridated water, but that would change if a new law is passed in Harrisburg.
For the first time in nearly 20 years, a proposal to require public water systems to add fluoride to their water is making progress in the state House of Representatives. House Bill 1649 was approved by two House committees this summer; on Nov. 1, it was referred to the appropriations committee.
“I think the momentum is there,” said Rob Pugliese, of the Pennsylvania Dental Association, which represents 5,500 dentists statewide. “We do feel there’s a much greater chance that this bill will pass than any in, say, the last five or 10 years.”
If House Bill 1649 passes, all public and community water systems that supply more than 500 customers would have to add fluoride to their water.
The change would affect most of the 85 or so water suppliers in Bucks County and 41 in Montgomery County.
In Bucks, only Bensalem’s water is fluoridated; it comes from the city of Philadelphia, which has added fluoride to its water supply for decades.
Places like Northampton, Middletown and Newtown also get fluoridated water from Philadelphia, but their systems also use water from local wells, so the level of fluoride fluctuates.
In Montgomery County, Pottstown is the only municipality that adds fluoride directly to its water.
An array of groups, including some water suppliers, environmental groups, and believers in holistic health, oppose the measure, for different reasons.
Supporters include a variety of health care, dental health, and community organizations, including the Pennsylvania Dental Association, the state Department of Health, and, closer to home, the North Penn Community Health Foundation.
Some area legislators who will be considering the bill, however, say they haven’t heard much about the issue.
Rep. Tom Murt, who represents the Hatboro area, said the only person who has contacted him about the bill was a dentist lobbying for his support for it.
“This is one issue that we don’t get much input on,” Murt said. “For me personally, I want to know more about it. I want to know about the cost of the program, and what the health effects are. And the only way to vet this is with public hearings.”
No public hearings have been scheduled.
If there were, though, an array of opposing arguments undoubtedly would be heard.
Some say water fluoridation is unnecessary, as most people are already exposed to fluoride through toothpaste and foods and beverages processed with fluoridated water.
Others say the practice is inefficient, as about 95 percent of household water is used for other purposes than drinking.
Still others oppose the cost burden on water suppliers, or argue that local communities, not the state, should make the decision to fluoridate their water.
And there are those who believe fluoridation chemicals, which are known to be unsafe at high levels, are unsafe at any level.
Still, fluoridation as a health benefit is pretty entrenched dogma in the United States. People who oppose water fluoridation for health reasons are often dismissed as wackos.
“Anyone who’s opposed to fluoridation is made out to be part of this crazy, right wing, crackpot network,” said Mike Ewall. “It’s like telling people the earth is flat.”
Ewall, who grew up in Bensalem and became active in an anti-incinerator movement in Lower Bucks, is now director of ActionPA. The Philadelphia-based organization works on grassroots, environmental justice issues, including fluoridation.
The weight of American medical institutions, including the American Medical Association, the American Dental Association and the Centers for Disease Control and Prevention, is behind fluoridation as the answer to reducing tooth decay.
Locally, the North Penn Community Health Foundation in September gave a $50,000 grant to the Pennsylvania Dental Foundation to support a year-long campaign to pass a fluoridation bill.
The local agency’s money brings to about $165,000 the amount of money funding the pro-fluoridation project, executive director Russ Johnson said.
Plans include a pro-fluoridation website, an infomercial and meetings to bring other community coalitions on board to support the effort.
“We’re hoping it’s a once and done thing,” Johnson said. “We’re hoping it will result in the commonwealth moving forward and mandating fluoride in public water systems.”
Fluoride is a form of the element fluorine. It is found naturally in many water supplies around the globe, including the United States. A different form of fluoride also is added to about half the water supplies in the country in the name of dental health.
Most health experts agree that constant, low levels of fluoride in the mouth help prevent tooth decay.
“It just makes the enamel stronger, and less prone to decay,” said Robert Solomon, a dentist with Hatboro Dental Center.
The question is how best to deliver the fluoride.
Though most countries in Western Europe stopped fluoridating their water in the 1970s, many dentists and public health experts here believe fluoridation is the best way to get fluoride to more people.
“We continue to believe strongly in fluoride as the single most effective public health measure to prevent tooth decay for the young and the old,” said Pennsylvania Dental Association’s Pugliese.
Fluoridation costs anywhere from 50 cents to $3 per year, per person, Pugliese said. But every $1 invested in water fluoridation saves $38 in healthcare costs, he said.
What about people who already use fluoride toothpaste and see a dentist regularly? Do they really need fluoride in their water?
“That might be true for kids in the suburbs, but what about all the kids who don’t have anybody to show them how to brush their teeth, or get to see a dentist except at an emergency clinic?” Pugliese said. “Fluoridation reaches across all socioeconomic boundaries.”
While that may be an admirable goal, some water suppliers say that’s the job of public health, not a water utility.
“The impact of fluoridation is worthy of public debate, and maybe there are some alternative measures to deliver it,” said Tony Bellitto, director of the North Penn Water Association. “But the public water supply cannot solve all socioeconomic problems.
“There is a range of dietary supplements that might be good for some people, from Vitamin C to calcium, but the public water supply should not be the vehicle through which that is delivered,” he said. “A large number of our customers have no need for or desire for those supplements.”
Ewall and others in the anti-fluoride movement say fluoridation is not the panacea that it’s made out to be. Rates of tooth decay have fallen dramatically around the world in the past 50 years, even in countries where the public water is not fluoridated, he said, pointing to data from the World Health Organization.
Still others think the issue should not be decided at the state level.
“We oppose the bill, because we feel it should be a local choice whether a community wants to fluoridate its water or not,” said John Brosius, of the Pennsylvania Municipal Authorities Association.
Plus, he said, people now get fluoride from many other sources.
“Many years ago, this was a universal way to get fluoride into everyone. But now you’ve got fluoride in toothpaste and so many other things,” Brosius said. “The sentiment here is, you’ve fluoridated 100 percent of your water for a very small percentage of use. But the legislators — I think they just look at it as a public health vehicle. I don’t know that they’ve looked at all sides.”