Without mentioning it to residents for nearly two years, the Sewerage & Water Board quit adding cavity-fighting fluoride to New Orleans’ drinking water supply after Hurricane Katrina and has not restarted because of a supply shortage.
S&WB Executive Director Marcia St. Martin said Wednesday that the agency got cut off from its supply chain because of Katrina and has been unable to resume deliveries because of a subsequent dearth of fluoride nationwide.
She said the water board, which started adding fluoride to tap water in 1974, did not notify the public because officials believed they would find a supplier.
“It’s not something we brought a lot of attention to,” she said in an interview. “We constantly thought we had a solution. In the last several weeks, we realized we’re not finding a supplier, no matter how much we try.”
Further, St. Martin said dental health guidelines are not based on the fluoride content of drinking water, so residents who follow those rules would not be affected by a lack of the compound flowing through their faucets.
“If you listen to the American Dental Association, the recommendation is that you always buy fluoride toothpaste, whether you have fluoride in the water or not,” she said.
However, an official with the state Department of Health and Hospitals who met with water board administrators and other dental and health professionals Wednesday to discuss the fluoride deficiency said the water board could have spread the news earlier.
“I think that maybe the physicians and dentists could have been notified, if not the public. They could have been prescribing supplements,” including drops and pills aimed at boosting fluoride intake in children, said Sheri Sison, manager of the Office of Public Health’s oral health program.
“People could have been a little more hypervigilant,” she said, though she said she did not believe S&WB officials acted with negligence.
In addition to New Orleans, five water plants in Plaquemines Parish, plus five others across the state, have not resumed adding fluoride to their drinking water since the storm, according to the health department, which tracks fluoridation as an “optional” water treatment. Plaquemines officials could not be reached Wednesday.
Meanwhile, 21 other systems, including those in Jefferson, St. Charles and St. John the Baptist parishes, have restarted the process, said Lauren Mendes, a health department spokeswoman. St. Tammany, which draws much of its drinking water through wells, does not use fluoride, a public works official said.
Mendes did not know why the state had not previously publicized the fluoride deficiencies.
Though City Hall also had kept the lack of fluoride under wraps, St. Martin said she expects city health director Dr. Kevin Stephens to release a series of letters beginning Friday to local physicians and dentists alerting them to the problem and requesting their help in finding a new supplier.
Before Katrina, the water board fed 417 pounds of liquid fluoride into the 120 million gallons of water it produced daily, St. Martin said. Its most recent supplier, Lucier Chemical Industries of Jacksonville Beach, Fla., provided the product from 1999 to 2005 at a total cost of $519,824.
Immediately after the storm, deliveries halted, she said.
Then in mid-2006, before the water board could restart its delivery schedule, the producer of most of the nation’s fluoride ramped down production because of equipment problems and poor-quality raw material, said Kip Duchon, national water fluoridation engineer with the Centers for Disease Control and Prevention’s oral health division.
That set off a feeding frenzy. Water utilities around the country rushed to stockpile fluoride, leaving laggards — or cities, like New Orleans, that were out of the loop — without any supply at all, Duchon said.
A request for bids by the S&WB on a fluoride supply contract failed to attract any takers in October, St. Martin said. Officials since then have hit dead ends trying to negotiate a deal, even though their fluoride storage facilities and the equipment that feeds the additive to treated tap water could be put to use immediately.
” We have not gotten a single bidder,” she said.
Duchon, however, suggested that the market is not as tight as the S&WB purports — if utilities know where and how to shop around.
“You really have to sort of be a little bit more deliberate about going to the distributors,” he said. You may have to say, ‘We may not do it with an open bid, we’d like to negotiate.’¤”
Duchon said that between two and five water utilities in every state are having problems securing sufficient supplies of fluoride. About 6,500 water systems across the country add the compound to tap water, he said.
About 70 percent of U.S. residents have access to fluorinated water, either because their supply is treated with additives or because groundwater tapped through wells contains fluoride naturally, he said.
Sison said the state health department, in tandem with the water board and local professional associations, agreed Wednesday to band together to mine the industry for fluoride suppliers.
“I’m hoping that maybe we can find some other companies that they haven’t contacted. Maybe the medical societies and dental societies could apply some pressure,” she said.
Though fluoride is available through medicines and dentist-office treatments, Sison and other experts stressed that providing it through drinking water is the most reliable and equitable delivery method, especially for poor residents and those without dental insurance.
Duchon said removing the compound from drinking water for a short time should not cause
major public health problems.
“Our general feeling is that if it’s less than six months, you’re probably not having a negative influence on the health of a community. If it’s more than six months, you really want to be aware of that,” he said.
“Your tooth doesn’t rot out in a period of a month,’ Duchon said. “It’s typically a one- to two-year process, and it can even take longer.”
Water board spokesman Robert Jackson said that in the absence of fluoride additives, New Orleans residents likely have benefited from residual deposits of the compound leftover from treatments by utilities north of the city that flow down the Mississippi River, which provides raw water for treatment plants near the Jefferson Parish line and in Algiers.
Duchon, however, said that a maximum 5 percent of an average municipality’s drinking water gets “recycled” back into the river, a volume unlikely to elevate the amount of fluoride to the public health standard in an immense waterway like the Mississippi.
“Surface water does not have sufficient fluoride,” he said.
St. Martin said fluoride also occurs naturally in river water, at concentrations of 2 parts per million to 5 parts per million, compared with the recommended therapeutic dose of 7 parts per million.
An eight-page pamphlet mailed recently to all New Orleans residents by the S&WB shows that even without a fluoride additive, fluoride levels in the city in 2006 met minimal requirements of the U.S. Environmental Protection Agency, which requires all water utilities to provide “water quality reports” to their customers annually.
St. Martin said the water board could not include a disclaimer in the mailer alerting residents to the lack of added fluoride in city drinking water.
“That document is very prescriptive by EPA standards,” she said. “We don’t have a lot of flexibility in that document.”