When fluoridation was new in the 1950s, many opponents were sure it had something to do with communism. All these years later, terrorists have replaced communists as America’s chief menace, but the debate rages anew about adding fluoride to the drinking water to help prevent tooth decay.

On the one hand, fluoridation has been hailed by the Centers for Disease Control as “one of the 10 great public-health achievements of the 20th century.” Since first being introduced in 1945 in Grand Rapids, Mich., fluoridation has grown to include the vast majority of public water systems. Fluoridated water is now supplied to 170 million Americans.

On the other hand, fluoridation opponents view fluoride as a poison that can cause a range of health problems, including cancer, and they argue that adding it to the drinking water to prevent dental decay in a minority of people with inadequate dental hygiene is philosophically akin to adding asthma medication to the air to treat the small minority of asthmatic people or appetite suppressants in the water to address the obesity epidemic.

It has been almost two decades since La Crosse County’s last big fluoride debate. In the late 1980s, Onalaska and La Crosse voters both passed referendums in favor of fluoridation, leaving Holmen as the county’s only public water system without a therapeutic level of fluoride. However, 2006 could be the year the fluoride debate returns to La Crosse County.

Holmen Village President John Chapman recently met with officials from the La Crosse County Health Department, including director Doug Mormann, to hear their pitch for the benefits of fluoridation. The meeting was at their request, and Mormann said the idea of pushing for fluoridation in Holmen came out of a dental care advisory council formed in 2005 by the area’s three legislators.

Chapman said it’s too early to speculate on what direction the village will take on fluoridation. “We’ll look into it. We will study it, but there aren’t going to be any immediate conclusions,” he said.

Back in 1996, then-Village President Sylvia Finch tried to sell the Holmen Village Board on the idea of fluoridation. She even arranged for a University of Wisconsin-La Crosse public opinion survey of Holmen residents on the subject.

Finch doesn’t remember the results of that survey, but her opinions on fluoridation remain the same as they were 10 years ago. “We really should have fluoridation in the water,” she said. “We’re the only place around here that doesn’t have it, which is kind of stupid.”

Chapman doesn’t remember the 1996 survey results, either, but in his years on the village board and as village president, he said he hasn’t heard much of anything from the public on fluoridation. In fact, he said, the only constituent he can remember bringing up fluoride was his dentist, who asked Chapman to have Holmen’s water fluoridated “when he had me in a compromising position with a needle in his hand.”

If the village board does decide to seriously consider fluoridation, Chapman said there would certainly be ample opportunity for public input, possibly even a referendum.

As for Chapman, he hasn’t made up his mind yet. “I can see both sides of the picture,” he said.

From Doug Mormann’s perspective as leader of the county’s health department, it makes good sense to add fluoride to the water supply. The relative cost of adding fluoride is low, he said, and that cost is more than made up for in the cost savings achieved by reducing tooth decay. Some estimates say that $38 is saved in dental costs for every dollar invested in fluoridation.

West Salem has been adding fluoride to its water since the 1950s, Mormann said. Almost all water contains some level of fluoride, and he noted that there is no need to add fluoride to Bangor’s water system because it already contains the necessary level to supply dental benefits.

“It’s particularly helpful in children, as they’re forming their teeth,” Mormann said. “As their teeth form, the fluoride gets into the tooth enamel and makes it more impervious to cavities. There’s scads of research that shows it’s very effective in reducing the number of dental caries.”

There also is plenty of research going back to the 1930s that indicates fluoride has no harmful effects at the concentrations recommended for public water systems, which is up to 1.2 parts per million. “It’s had such a long history,” said Warren Lemay, the chief dental officer for the Wisconsin Division of Public Health.

About 90 percent of Wisconsin residents who get their water from municipal systems get fluoride in their water, Lemay said. That amounts to about 63 percent of the Wisconsin population overall. Wisconsin ranks about 12th among the 50 states in percentage of people getting fluoride in their water, despite leaving the decision to fluoridate up to the individual municipalities.

Minnesota and Illinois, he noted, are among the 14 states that requires fluoridation of all municipal water systems.

Fluoridation of public water systems is endorsed by organizations including the American Dental Association, the American Medical Association, the World Health Organization, the U.S. Public Health Service and the American Cancer Society, among others. “All these organizations are saying we’ve got 50 years of research” that shows fluoridation is safe and effective, said Dr. Randy Moseng.

Moseng divides his time between dental offices in Holmen and La Crosse, where most of his patients get fluoridated water. The difference, he said, is “night and day.”

“There’s much more decay in the Holmen kids than the ones I see in La Crosse,” he said. “I say fluoride is to teeth as calcium is to bones. It’s like a vitamin for your tooth, in a way.”

In a growing community like Holmen, a lot of the residents are new, moving there from other communities where fluoride had been in the water so long they’ve never known it to be an issue. “What I’m hearing from the moms is why don’t we have it here?” Moseng said. “For my money, it’s very safe and it’s very effective. Š I’m behind it 100 percent, and I can’t imagine a dentist who wouldn’t be.”

As hard as it is for Moseng to picture a dentist opposed to fluoride, it’s just as hard for Mike Berkley to imagine why any reasonable person would be in favor of fluoridation. A Brice Prairie resident and chiropractor, Berkley opposes adding fluoride to public water systems not just as a health danger but on principle.

“The real issue is about freedom of choice and global mass medication without informed consent,” said Berkley, whose late father-in-law, renowned chiropractor Fred Barge, led the fight for many years against La Crosse fluoridation.

Rather than put fluoride in everybody’s water, Berkley said it makes more sense to spend that money targeting people at high risk of tooth decay, improving their dental hygiene and access to dental care and providing individual fluoride treatments rather than “medicating” everyone.

“Everybody wants to elevate their communities Š but you can’t do it by a shotgun approach,” he said. If something like that (a water additive) could stop cancer, let’s try it. But for cavities? It’s insane.”

Berkley and other fluoridation opponents say studies cast doubt on just how effective it is in preventing tooth decay and how safe it is to have fluoride in the public drinking water. People get a lot more fluoride than just what they drink in their water, Berkley said, because fluoride also is in food and beverages made with fluoridated water.

“It’s scientifically impossible to know with certainty what the long-term health effects of fluoridation are on the human body,” Berkley said. “According to many authorities, fluoridation can be linked to bone cancer, increased risk of bone fractures, osteoporosis, arthritis, learning disabilities and brain damage.”

Berkley’s not surprised that fluoride would surface again as an issue in La Crosse County. What’s surprising to him, though, is that the subject didn’t come up in conjunction with an effort to discontinue fluoridation. That’s the trend, he said, and fluoridation opponents are winning battles all over the United States, in Canada and in European countries including Finland, Sweden and Germany.

The growth in fluoridation opposition is especially evident on the Internet. Fluoride foes – such as the Fluoride Action Network, Parents of Fluoride Poisoned Children and Citizens for Safe Drinking Water – have launched a formidable flotilla of Web sites with articles, images and links to other sites related to fluoride.

“There’s so much information out there, you can’t believe it,” Berkley said. “This fight has been fought 1,000 times before.”

If the Holmen Village Board does decide to consider fluoridation, Mormann said he expects there will be a spirited debate. “It’s very appropriate to have good deliberative discussions on public policy issues like this,” he said. “It’s an important public health issue, but it’s also an important municipal government decision.”

Contact Randy Erickson at randy.erickson@lee.net or 786-6812.

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FLUORIDE FAST FACTS

FIRST: The first municipal water system in the United States to be fluoridated to prevent tooth decay was Grand Rapids, Mich., in 1945.

LA CROSSE COUNTY: The city of La Crosse first added fluoride to the public water system in 1953, but discontinued the practice soon after because of public opposition. A referendum in April 1954 rejected fluoridation by a vote of 10,623 to 2,356. Two votes in the late 1960s failed before La Crosse voters approved fluoridation in 1988 by a vote of 8,406 to 6,291. Onalaska approved fluoridation about the same time as La Crosse, and West Salem has been fluoridated since the 1950s. Holmen has the only La Crosse County public water system with fluoride levels below that deemed appropriate for preventing tooth decay. Bangor has enough naturally occurring fluoride in its groundwater so it does not need to introduce any into its public water system.

WISCONSIN: As of 2002, about 280 Wisconsin municipalities had fluoridated water, covering 90 percent of the population on municipal water system and about 63 percent of the total population.

NATION: In 2000, about half of the U.S. population received fluoridated water from a municipal system.

PREVENTION: A fluoridated community should see about a third fewer dental cavities compared with a nonfluoridated community, said Warren Lemay, chief dental officer with the state Division of Public Health.

FLUOROSIS: The Centers for Disease Control released a study last year that indicated 32 percent of American children suffer from dental fluorosis, a discoloration of the teeth ranging from tiny white spots to brown mottling. Fluorosis is caused by ingestion of too much fluoride, which health officials attribute largely to swallowing of fluoridated toothpaste by children.

CANCER: The Environmental Working Group, a watchdog group, petitioned the National Institutes of Health to list fluoride in tap water as a carcinogen. The National Academy of Sciences found “no credible evidence for an association between fluoride in drinking water and the risk of cancer,” but the academy launched a review, with results expected to be released in February.

ENDORSEMENTS: Fluoridation is is endorsed by organizations including the American Dental Association, the American Medical Association, the World Health Organization, the U.S. Public Health Service and the American Cancer Society.

OPPONENTS: Fluoride foes include the Fluoride Action Network, Parents of Fluoride Poisoned Children and Citizens for Safe Drinking Water.