It all comes down to demand.
A 1995 state law requires cities to add cavity-fighting fluoride to water supplies, if and when state funding becomes available. In the absence of state help, cities can tackle the expensive task on their own. But in Napa, officials say the urgency just isn’t there.
“You know, I have not had one request, I have not had one inquiry,” said Napa Mayor Ed Henderson, who is serving a second term as mayor. “It doesn’t seem to be high on the list of the citizens as far as I can see. They may have talked to other people, but as for me, I haven’t had any pressure or requests.”
Over 84 percent of U.S. children, 96 percent of adults and 99.5 percent of those 65 and older have experienced tooth decay, according to the U.S. Centers for Disease Control and Prevention. It’s a problem experts, including those at the American Dental Association, say can be curtailed by adding fluoride to public water supplies at 0.7 to 1.2 parts per million.
Napa’s water supply, as well as the water supplies of Calistoga and Yountville, contains a 0.1 natural dose of fluoride.
“We are literally just swimming in decay in Napa, especially with children and seniors and folks of lower income,” said Dr. Edward Bartlett, clinical director of the nonprofit Sister Ann’s Dental Clinic. “Most communities in the U.S. either have it naturally or have it adjusted.”
Before coming to Napa, Bartlett practiced in Great Falls, Mont., where fluoride was naturally occurring.
“It’s hard for dentists to make a living there,” Bartlett said.
In contrast, Sister Ann’s, which serves low-income patients, is booked solid for regular appointments through the end of May.
“In the 50-plus years that (water fluoridation has) been in effect it has shown to be the single-most effective way to prevent tooth decay,” Bartlett said.
“But Napans are denied that. It’s terrible.”
According to the CDC, roughly 66 percent of the nation’s population served by community water systems receives optimal levels of fluoride, and those communities experience an 18 to 40 percent decrease in tooth decay.
The center also found that for larger communities of more than 20,000 people, where it costs about 50 cents per person to fluoridate the water, every $1 invested yields $38 savings in dental treatment costs.
Despite its advantages, fluoridation has its opponents, who see fluoridation as either too much government intervention or as a danger to public health.
“It isn’t a matter of Big Brother, it isn’t an ethical issue, it isn’t a legal issue. It’s strictly a political issue,” Bartlett said.
Bartlett points to the 1996 ill-fated effort by the Suisun Water Board to fluoridate the water supply.
“In the fluoridation effort I was part of, the politicians ignored all of the science and believed a handful of people who came from out of the area,” Bartlett said. “They listened to the wackos.”
Phil Brun, general manager for Napa Water District, said his agency receives about 10-15 phone calls each year asking about fluoridation.
“Most of the time when I respond, ‘No, Napa doesn’t fluoridate,’ people say, ‘Oh, that’s good.'” Brun said. “About 50 percent has said that.”
A 1996 city study estimated it would cost $189,000 to install fluoridation equipment at the city’s three treatment plants, and another $20,000 per year for operation and maintenance. Adjusting for inflation, Brun figures it would now cost $500,000 to $800,000 for installation and $100,000 for annual upkeep.
According to the state law, funding cannot come from taxpayer monies or through raising water rates, Brun said.
This leaves jurisdictions to wait for money from the state — Napa County ranks 17 out of 166 districts on the state’s priority list — or hunt for funds locally.
“It’s a wait until the state contacts you (or) wait until a special interest group here in Napa makes that political push,” Brun said.
Ultimately, the City Council has to deem fluoridation a priority in order to earmark local funds for the project, Brun said.
“The City Council’s job is to budget and prepare capital improvement programs that we as the professionals and they as the politicians feel are appropriate for the community,” Brun said.
Until the water meets state standards, Bartlett will continue to teach his patients at Sister Ann’s how to do their best on their own.
He tells patients to buy fluoridated water for drinking, and supplement that with fluoridated toothpaste and mouthwash.
“Fluoride works by healing a cavity as it occurs,” Bartlett said.
“If you have a cavity and the water has no fluoride, the cavity just gets deeper. If water comes across the cavity that has fluoride, it stops it.”