As a University of Pennsylvania dental student in the late ’60s, Joseph R. Greenberg noticed a curious difference in the mouths of the low-income children he treated at the school’s Philadelphia clinic and those he saw at his externship in Coatesville.
“The Philadelphia kids all had perfect teeth, maybe a few cavities,” he said. “In Coatesville, there were just giant holes where teeth should have been.”
The difference, said Greenberg, who runs a cosmetic dentistry practice in Villanova, was fluoride.
Philadelphia has added the enamel-hardening mineral to its public water since 1955, after a glut of research credited fluoride with a dramatic reduction in cavities and tooth decay among those who drank treated water.
But despite government proclamations calling water fluoridation one of the most important public-health achievements of the 20th century, the rest of the region has been slow to follow.
The percentage of Pennsylvanians with access to fluoridated water – about half – has been nearly stagnant the last 20 years, even as fluoridation rates have steadily increased to about 70 percent in the rest of the country, according to the Centers for Disease Control and Prevention.
Efforts to add fluoride to public water in the state have routinely met stiff resistance. And some communities – like Pottstown, which decided this month to stop fluoridating its water after five decades – have given up on the process.
In New Jersey, the statistics are more dramatic. The percentage of the population with fluoridated water plummeted from a quarter in 2006 to just under 14 percent in 2008, the latest year for which CDC statistics are available.
“The attraction to fluoride has waned over time,” said Ronald C. Downie, chairman of the Pottstown Borough Authority, which manages the water system. “We’re not out in front of this. We’re just reflecting the trends.”
The exact reasons for the region’s resistance to fluoridation remain elusive. Each dentist seems to offer a different explanation.
In this age of fluoride toothpastes and mouthwashes, some argue that the public benefit of injecting it into the water supply has waned. Others point to the efforts of groups like the Fluoride Action Network, which travels the country opposing public fluoride use, pointing to studies that it says link the chemical to brittle bones and perhaps even cancer.
Most experts dismiss those assertions as pseudoscience. But Jim Schulz, governmental affairs director for the New Jersey Dental Association, has seen the effects that antifluoride groups have had on legislators over the years.
“There are always these groups that look at any public-health campaign as a conspiracy or a communist plot,” he said. “But fluoridation is the right public-health policy. It’s simply the most cost-effective, universal thing we can do to promote dental health at the moment.”
Fluoridation of public water began in 1945 in Grand Rapids, Mich., and expanded rapidly across the country in the years after World War II. Since then, the percentage of teens with decay in at least one tooth has declined from about 90 to 60, the CDC said.
But resistance existed from the beginning, ranging from libertarian-minded skeptics who objected to the government’s adding anything to water to conspiracy theorists convinced that fluoridation was part of a communist plot to sedate the populace.
These days, antifluoride activists are more likely to focus on perceived health risks. They point to research such as a 2006 study from the National Academy of Sciences that found excessive fluoride consumption – well above the government’s recommended level – could lead to crippling bone abnormalities.
These arguments have held sway locally in government decisions. Legislators in New Jersey repeatedly introduced bills that would have mandated fluoridation for the state’s water systems. Each time, intense lobbying from antifluoride activists left the bills dead on the Statehouse floor.
A 2003 effort to begin adding fluoride to water in Yardley, a Bucks County community of about 2,500 on the Delaware River, drew such loud opposition from residents that area governments eventually abandoned the plan.
“It used to be that city councils were convinced that this was good for poor people, and fluoridation plans would be passed before anyone knew about it,” said Carol Kopf, a spokeswoman for the Fluoride Action Network. “Now there’s a real groundswell. People are getting their information on their own.”
Fluoride opponents claimed another victory this year when the federal government lowered its recommended fluoride level for water supplies from up to 1.2 milligrams per liter to 0.7, saying excessive consumption had led to fluorosis – a condition marked by tooth spotting or streaking – in about two out of five teens.
The advisory was the government’s first public concession that mandated fluoride use could pose some harm, although any danger was largely cosmetic and largely noticeable only to trained dentists, it said.
Pottstown’s decision offers yet another explanation for fluoridation’s waning popularity here – money.
The move will save the authority about $40,000 a year, a drop in the bucket compared with the agency’s $5 million operating budget. But there is real money to be made in water sales.
For years, the authority ran Montgomery County’s only fluoridated water system. Downie hopes the change will allow it to begin selling its four-million-gallon daily surplus to neighboring suppliers who do not use fluoride.
It’s an argument that even Aram Ecker, a Pottstown plumber and the lone authority member to vote for continued fluoridation, can get behind.
Ecker argued vehemently with his fellow authority members, offering his own children as examples of fluoride’s benefits. “It’s ridiculous the silver that’s in my mouth,” he said. “I have seven kids. They’ve all got perfect teeth as far as cavities. I know it’s because of the little bit of fluoride in my water.”
Weeks later, he still believes residents will lose a tremendous health benefit. But if outside sales mean lower water bills, he said, he is willing to get his fluoride elsewhere.
“If it means we can lower rates,” he said, “you’re damn right I can be bought.”
Print 
PDF