On Nov. 4, local residents will vote on whether to opt out of a state mandate requiring the city to fluoridate its drinking water. The fluoride issue has come to a vote twice before in North Platte and was defeated both times.

Earlier this year, lawmakers adopted a bill (LB 245) that requires any city in Nebraska with a population of 1,000 or more to fluoridate their water supply by June 1, 2010, unless the residents vote to opt out of this state mandate.

North Platte is one of 46 communities in Nebraska that will be voting on the issue this year, according to Dr. Jessica Meeske who is a pediatric dentist and a member of the Nebraska Dental Association, which supported LB 245.

“The Nebraska Dental Association supports water fluoridation because it’s the single most effective thing that we can do to prevent tooth decay on a population basis,” Meeske said.

She noted the amount of fluoride that would be added to the city’s water supply would be one part fluoride per one million parts water, which she said is about the equivalent of one drop in a bathtub full of water.

While that may not sound like a lot, Dr. Paul Connett of the Fluoride Action Network feels this level can be toxic. By comparison, he noted that the level of fluoride in a mother’s breast milk is only 0.004 parts per million. He said this means typical fluoridated water has about 250 times more fluoride than what nature intended.

“I do not think that is a sensible thing to do,” Connett said during a recent phone interview.

Connett, a retired professor who specialized in environmental chemistry and toxicology, is the executive director of the Fluoride Action Network – a national organization that seeks to educate people about the risks of fluoride.

Meeske said water fluoridation is proven to be safe. In fact, she said it has been endorsed for decades by every major public health authority, including the Centers for Disease Control and the American Medical Association.

“It is considered one of the top 10 public health successes of the 20th century, right along with immunizations and motor vehicle safety,” Meeske said.

She said she has seen the benefits of fluoridation first hand. Of the more than 200 children she sees at her practice in Hastings, several are referred from the North Platte area because their tooth decay is so severe.

Meeske said she feels fluoridated water has a very wide margin of safety, which is what makes it such a good public health policy. However, Connett disagrees about the safety margin because fluoride is biologically active.

“There’s no question that we’re dealing with a highly toxic substance,” Connett said.

He noted there are 23 published studies showing that fluoride decreases a child’s IQ. He said these studies were done in countries like India, China, Mexico and Iran, where the children get higher levels of fluoridated water.

Yet he feels the basic question for consideration is whether there is an adequate margin of safety, and whether it is possible to guarantee the safety of everyone, including young children and the elderly.

“I would stake my whole scientific credibility and reputation on the statement that there is no adequate margin of safety to protect everyone in society,” Connett said.

He said there is a large amount of research that indicates that the major benefit of fluoride is topical rather than systemic: “In other words, it works from outside the tooth, not from inside the body.”

However, Meeske said fluoridated water that is ingested in small amounts on a regular basis can have a significant systemic effect as the fluoride is absorbed by the body and secreted through the saliva.

“It is bathing your teeth all day long with a mineral that naturally makes the teeth hard,” Meeske said.

In addition, Meeske said the fluoride that is absorbed by the body also becomes incorporated into the teeth as children develop, hardening the teeth at the point where it is developing under the gums.

Yet too much fluoride can cause dental fluorosis, according to Connett. He described dental fluorosis as a disruption in the development of the enamel before a child’s permanent teeth have erupted.

As one can see, there does not appear to be a simple answer to the fluoride debate. Yet there are many communities that have been adding fluoride to their water for more than 50 years because of the apparent benefits.

“Seventy-seven percent of Nebraskans already have access to fluoridated water,” Meeske said, adding that she feels the citizens of North Platte should have the same benefit that the rest of the state already enjoys.

Meeske said the benefit of fluoridated water is measurable, and studies have shown that fluoridation can reduce tooth decay by about 40 percent. And not only is it effective, it is also cheap.

“For every dollar we invest in water fluoridation, we’re going to save $38 in treatment,” Meeske said.