So far, tooth fairies have had it great in San Jose: The city is the largest in the country that doesn’t fluoridate its water. But now a major effort is under way to shed that title.
In a push toward better dental health in the valley, advocates have launched a campaign to raise the millions needed to upgrade the city’s water infrastructure. Given the controversy that typically surrounds fluoridation efforts, they expect progress to be slow. So on Wednesday backers of the effort brought a top engineer from the Centers for Disease Control and Prevention together with San Jose Water Co. officials to begin talking science and quelling myths.
“California is really behind,” said Kip Duchon, the fluoridation engineer who presented the workshop. “So we’re very excited at the CDC to know that the people of Santa Clara County are really ready to take this important health initiative.”
About 70 percent of community water systems in the United States are treated with fluoride, recognized by international health experts as a key method in preventing tooth decay, particularly among children. In California, only 30 percent of water systems are fluoridated, Duchon said, partly because of the state’s highly complex water systems.
San Jose’s system, for instance, includes more than 100 wells at almost 30 sites. So the water company has been reluctant to take on the task and find the money for it.
“The health question is not really in our purview,” said company spokesman John Tang. “We need to better define what technology is out there to help us fluoridate the water in the most cost-effective way.”
Owned by stockholders
San Jose Water Co., which provides water to the vast majority of the city, is a publicly traded company beholden to stockholders, not voters or county officials. So it has little motivation to help finance the treatment system. But a state law passed in 1995 mandates that if the money for equipment and initial maintenance costs are provided by sources other than the utility or its customers, water companies must build fluoridation systems.
The Health Trust, a Campbell-based foundation that funds health projects, is launching a capital fundraising campaign to cover those costs. Early estimates put the project’s price tag at $18 million. But parties on both sides contest the number, so the trust, with support from Santa Clara County and the city, wants to commission an engineering study to find out exactly what needs to be done for exactly how much.
The Health Trust took on the issue of children’s oral health six years ago, opening a dental clinic and buying a “tooth mobile” for screenings. But they found so many cavities, especially among children from low-income families, they wanted to focus more on prevention.
“We can never drill our way out of this issue if we don’t spend time looking at the upstream solution of fluoride,” said Fred Ferrer, CEO of the trust. “You’re not serious about oral health if you’re not using one of the best prevention methods you have.” (Pockets of San Jose that aren’t served by the water utility added fluoride to their water years ago.)
Numerous studies have shown that optimal levels of fluoride in water, about 1 milligram per liter, strengthen teeth and slow down bacteria that causes decay. Decay rates are reduced by 18 to 40 percent in communities with fluoridated water, according to the CDC. A California statewide study published in 1999 found that, on average, kids who lived in communities that did not have fluoridated water had one tooth more that was decayed or filled than kids in fluoridated areas.
In Santa Clara County, Health Trust officials found in 2001 that one in three kindergartners and third-graders had untreated tooth decay. Those numbers are higher than the statewide averages — about 28 percent of kindergartners and 29 percent of third-graders, according to a 2006 statewide survey by the Dental Health Foundation.
But fluoride opponents claim tooth decay is a result of too much sugar, not lack of fluoride. And they argue kids are getting plenty of fluoride as it is — maybe even too much.
“Kids are getting fluoride in juices, in processed sandwich meats, like bologna and hot dogs. Chicken sticks are loaded with fluoride,” said Maureen Jones, an archivist for Fluoride Action Network and Citizens for Safe Drinking Water. “The real culprit of tooth decay in low income children is putting kids to bed with baby bottles and sippy cups filled with soda or juice.”
Jones and others worry about kids overdosing on fluoride, which can cause a condition called fluorosis, where teeth become discolored or brittle. She cites other studies that link fluoridation chemicals to bone cancer, decreased thyroid function, and lowered IQ — studies that most scientists dismiss by pointing at the large body of peer-reviewed research indicating fluoridation is safe, healthy and effective.
With the recent, budget-driven elimination of the state’s adult Denti-Cal program, and sweeping cuts to the Healthy Families program that provides dental insurance to kids from working-poor families, fluoride advocates emphasize the overall savings in health care costs. Fluoridation costs between 50 cents and $2 a person per year; the lifetime expense is less than the average cost to fill one cavity, about $150.
“I’m very anxious that San Jose gets fluoridated,” said Dr. Donald Lyman, chief of chronic disease at the California Department of Public Health, “so I’m not embarrassed to have the largest city that is not fluoridated in my jurisdiction.”