When most New Yorkers drink water from their faucets, they take part in a public health initiative that is marking its 60th anniversary this year.
Fluoride, a naturally occurring element, is added in small amounts to 73 percent of the drinking water in New York state, including 90 percent of public water in Westchester. Nationwide, 67 percent of public water was fluoridated as of 2002, according to the national Centers for Disease Control and Prevention.
But not in Rockland.
The county’s public water supply has never been fluoridated, and the reasons touch on a debate that has raged nationwide over fluoride for more than a quarter-century.
To its supporters, fluoride is an unqualified success — a simple, safe measure that pays long-term dividends in improved dental health.
“Fluoridation is one of the best things that has happened from the standpoint of public health as far as dentistry is concerned,” said White Plains dentist Malcolm “Sandy” Graham, a member of the board of governors of the New York State Dental Association. “There is zero downside.”
Not everyone agrees. For as long as health experts have hailed fluoridated water as a safe and effective way to prevent tooth decay, there have been critics who insist that fluoride is a dangerous substance that causes cancer. The debate was renewed recently when an unpublished study by a Harvard graduate student suggested a link between fluoridated water and osteosarcoma, a type of bone cancer. It was posted on the Internet.
“The evidence has grown more convincing over the years,” said Long Island resident Carol Kopf, a member of the New York State Coalition Opposed to Fluoridation and spokeswoman for the nationwide Fluoride Action Network. “Fluoride doesn’t reduce tooth decay. It’s harmful to some and a waste of money.”
Fears about possible negative effects of the mineral fueled the great fluoride wars of the late 1970s in Rockland.
“It would cause cancer. It was part of a communist plot. It was medicating people against their will — those were some of the arguments,” recalled Edward S. Fisher, a longtime pediatric dentist in Tappan, who spoke in favor of fluoridating Rockland’s water then and still supports the idea. “To the great detriment of generations of children in Rockland, the anti-fluoridationists won.”
Michael Schachter, a Suffern physician who practices alternative medicine, was a leader in Rockland’s anti-fluoride movement in the 1970s.
He’s even more convinced now than he was then that fluoride is dangerous.
“It’s amazing to me that fluoride is still being promoted,” he said. “It’s more toxic than lead — the effort should be to get it out of the water, not to put it in.”
Despite public opposition, the Rockland Board of Health voted in 1978 to add fluoride to the county’s public water.
Health officials at the time said the move would ensure the dental health of children in the county.
But local politicians intervened and appointed anti-fluoride members to the Board of Health. The board in 1981 repealed its 1978 vote in favor of fluoridation. The issue has never come up again.
Rockland dentists say they see the results of that battle in their offices every day: children with cavities.
Geri-Lynn Waldman, a pediatric dentist in New City, treated youngsters during her training in New York City and in New Jersey communities that fluoridated water before joining a pediatric dental practice in New City.
“I see a lot more cavities here than I did in New York City or New Jersey,” she said. “There is a big difference.”
Children can get fluoride from sources other than drinking water. Many Rockland pediatricians and dentists routinely prescribe multivitamins with fluoride for their young patients.
New City resident Lisa Backelman has become accustomed to giving multivitamins with fluoride to her four children ranging in age from 3 to 11.
“I grew up in the generation where the prevailing viewpoint was that fluoride is good for your teeth,” she said, adding that she was surprised to learn that Rockland’s water was not fluoridated.
Children who visit dentists also get fluoride treatments at regular intervals.
“But that doesn’t really help people in lower socioeconomic groups who don’t have the means to take their child to the doctor or dentist,” said Spring Valley dentist Willie Bryant, who is active in the local chapter of the National Association for the Advancement of Colored People.
One of the biggest advantages of fluoridating water is that it provides universal access to dental protection, he said.
Dr. Joan Facelle, a pediatrician and Rockland commissioner of health, supports the idea of fluoridated water. “Fluoride is a safe and effective way to promote the dental health of children,” she said.
It also makes sense as a public health measure, she said. “It protects everyone equally, including young children who do not have access to dental care,” Facelle said.
Facelle said that she has not seen any convincing evidence that fluoride causes cancer or any other disease.
But Fletcher Johnson, a Nyack physician who was on the Board of Health in the 1970s and remains a member today, said he is still opposed to fluoridation.
“I don’t think it should go into the water,” he said. “I voted against it then, and I would vote against it again.”
At a joint meeting in July to celebrate the 60th anniversary of Grand Rapids, Mich., becoming the first community to adjust the fluoride content in the public water system, both the CDC and the American Dental Association cited numerous studies showing that fluoride in drinking water is both safe and effective at preventing tooth decay. Anti-fluoride activists, including Kopf, picketed outside the meeting.
“Community water fluoridation is the single most effective public health measure to prevent dental decay and improve oral health over a lifetime for both children and adults,” Dr. Richard H. Carmona, U.S. Surgeon General, said in a statement released during the meeting.
Fluoridation of community water supplies in the United States has grown from 230,000 people in 1945 to more than 170 million people in 2002.
Both the CDC and the dental association vowed to step up the efforts to get more communities to begin water fluoridation.
There is no technological reason why fluoride couldn’t be added to Rockland’s water, said Rich Henning, spokesman for United Water, the utility that supplies most of the county. “But it might be expensive,” he said.
Rockland’s public water comes from several sources — Lake DeForest in Clarkstown, 10 wells adjacent to the Ramapo River and other public wells throughout the county. Systems would have to be created at each site, he said. Some communities have their own water systems.
It probably would be easier to overcome technical barriers to fluoridating Rockland’s water than it would be to overcome reluctance to revisit the contentious issue, local experts predict.
“Fluoridation is the right thing to do,” said Fisher, who recalled the bruising fluoride wars of more than 20 years ago. “But in Rockland the battle is not winnable. Who wants to go tilting after windmills?”