It became a household word in the 1950s, when Crest toothpaste taught kids everywhere to smile and proclaim, “Look, Ma, no cavities.”
But in the decades since, the proven benefit of fluoride in fighting tooth decay has been offset by unproved yet widespread criticism that the chemical additive causes everything from osteoporosis to cancer.
The debate is taking root in Brookfield, where a dental hygienist is pushing city officials to put fluoride in the public water supply to ensure that kids are protected from cavities.
Many other cities throughout Wisconsin fluoridate their water systems, with the blessing of public health professionals.
According to the state Department of Health and Family Services, about half the municipal water systems in Wisconsin use fluoride, reaching about 63% of the state population. That includes residents in Milwaukee, Oak Creek, Glendale, Cudahy, South Milwaukee, Waukesha, Menomonee Falls, Pewaukee, Oconomowoc, Cedarburg, Port Washington, Grafton, Saukville, Racine, Kenosha, Germantown and West Bend.
“It should be a no-brainer,” said Thomas Hughes, president of the Wisconsin Dental Association.
But a growing anti-fluoride movement is raising concerns throughout the United States about the risks of promoting healthier smiles by what it views as tampering with our water.
Voters in several communities, including Spokane, Wash., and Logan, Utah, went to the polls in November to shoot down referendum plans aimed at introducing fluoride into their water systems.
Residents of Shawano, a city of about 7,000 near Green Bay, likewise rejected a fluoridation plan.
Brookfield Public Works Director Tom Grisa said he expects that city leaders in his Waukesha County community will find no easy – or universally accepted – answers.
“I had no idea it was so controversial,” he said.
The issue surfaced a few months ago, when dental hygienist Mary Ellen Thiede discovered that unlike many nearby communities, Brookfield does not treat its water with fluoride.
Thiede, a mother of two, said she lived in the community 14 years assuming that the city water contained fluoride. She stopped giving her kids fluoride pills when their house was switched from a private well to municipal water five years ago.
By chance, a relative relocating to Brookfield recently inquired at City Hall and learned that the water was not fluoridated.
“I just felt sick,” Thiede said. “This is not a new concept. It’s not like we’re living in the dark ages.”
New Berlin also does not fluoridate water. It is not considering fluoridation.
“I don’t know if it’s not high on the list of people’s priorities or if they’re just satisfied,” New Berlin Water Superintendent Tom Krumplitsch said.
Cedarburg Water Superintendent Dennis Hintz said his community has been using fluoride for more than 40 years, and that there has never been any sign of adverse health effects among the 10,000-plus residents.
Still, despite the cavity protection, some residents remain unnerved about fluoride.
“Occasionally, we get people calling up and saying, ‘You’re poisoning us,’ ” Hintz said. “There’s always been some skepticism. But nothing’s even been proven.”
TheAmerican Dental Association estimated that 70% of the cities with populations of 100,000 or more in the United States add fluoride to their water, including 42 of the 50 largest cities.
In Wisconsin, state health officials said, most of the municipal water systems without fluoride are in small communities where residents are turned off by the cost or by the perceived health hazards.
Warren LeMay, chief dental officer for the state, said Shawano voters were the latest to turn down fluoridation because of what he called the “scare tactics” of opponents.
“We have the anti-fluoridationists who are so opposed to it,” he said.
In recent months, the U.S. surgeon general has endorsed fluoride in public water, and reports in the British Medical Journal and other sources have attempted to dispel the fears of dangerous side effects.
Hughes, the dental association president, said he regards some opposition as unfounded anti-government hysteria.
“Some people don’t believe in vaccinations, either,” he said.
But the anti-fluoride movement has supporters who have argued that there is equally strong evidence against widespread use of the chemical.
Jeff Green, director of the California-based Citizens for Safe Drinking Water, said advocates for fluoridation of municipal water often fail to understand how many other sources of fluoride are out there already.
Green said people consume fluoride in soft drinks, breakfast cereal and many other common foods.
“The exposure levels are going higher and higher and higher,” he said.
As a dental treatment, fluoride strengthens the enamel on teeth and helps fight decay. Some fluoride occurs naturally in water but usually not at levels high enough to protect teeth to the same degree.
The optimum level for fighting tooth decay is generally regarded as 1 part per million, roughly a few drops in each gallon of water.
In the estimated 25 wells that pump water to the surface for the Brookfield municipal system, naturally occurring fluoride has been recorded at levels as high as seven-tenths of 1 part per million.
Even some supporters of fluoridation have acknowledged that too much of the chemical is not healthy.
Petwara Toyingtrakoon, a municipal water supply engineer for the state Department of Natural Resources, said cities must monitor their fluoridation systems around the clock to make sure they are maintaining the proper levels. She has never heard of any mishaps and supports fluoride in public water.
“If it’s in the right dose, it’s good for the kids’ teeth,” she said. “If it’s not in the right dose, it can be toxic.”
Similarly, many cities use low levels of chlorine, another potentially toxic chemical, to kill bacteria in public water.
Brookfield officials have estimated that it would cost at least $725,000 to launch fluoridation and $75,000 a year to operate the system, resulting in higher water bills for residents.
Officials plan to study the issue and perhaps form a task force to make a recommendation.
Thiede, a dental hygienist for 18 years, said she has seen evidence of the benefits of fluoride, with fewer and fewer kids having to face the dentist’s drill.
“I look at teeth all day,” she said. “I don’t know if you’ve spent a lot of time in a dentist’s chair – it isn’t a lot of fun.”