More than 65 years after the United States began fluoridating its water, Santa Clara County is just now beginning a debate over whether to offer fluoridation for many of its 1.8 million residents who do not already have it.
Todd Hansen, chief operating officer of the HealthTrust in Campbell, Calif. has been working to get fluoridated water for San Jose residents and eventually the whole of Santa Clara County for the past two years. At the HealthTrust, a charitable foundation focused on public wellness in the Silicon Valley, Hanson has led many health campaigns in Santa Clara County, but for the past 10 years one issue has been perennially at the top the HealthTrust’s agenda, children’s teeth.
In 2008, the HealthTrust, partnering with the Children’s Dental Group, which operates children’s dental offices throughout California, opened the Children’s Dental Center in east San Jose. In the city “the state of oral health of the children that we see,” Hanson said, is “scary. It became clear fairly quickly that we will never be able to drill our way out of the problem.”
Generally, Hansen is soft spoken and deliberate, but when speaking on the topic of children’s health, an edge of earnest concern sharpens his words.
Dr. Howard Pollick, a specialist in dental public health recognized by the American Dental Association and a long-time fluoridation researcher, said the data highlighting the benefits of fluoridation for children’s oral health is clear. As the principal investigator in a study of the state of elementary-age children’s teeth in the Bay Area in 1993-94, Pollick found that, in fluoridated areas, children averaged 2.7 decayed, extracted, or filled teeth, while in unfluoridated areas children averaged 3.71.
In 2006, a survey of children’s teeth by the Dental Health Foundation, a California non-profit now known as the Center for Oral Health, found that two-thirds of kindergarteners through third graders in California had some tooth decay. This study did not consider fluoridation in its research, but it did confirm that children’s oral health was still a problem in California.
Seventeen years after the 1993-94 study, Hansen is still working to get San Jose’s water fluoridated with the hope that fluoridated water, though not a total solution, will give children in San Jose one more defense against tooth decay.
Even when Pollick performed his study almost 20 years ago, fluoridation was a well-established public-health practice in much of the country. In 1945, six cities in Michigan, New York, Illinois and Ontario began adding fluoride to their water supplies. Testing over the next 13-15 years in these areas showed that tooth decay in children was reduced 50-70 percent.
Since 1945, according the American Dental Association, most of the nation’s biggest metropolitan areas have opted to fluoridate their water supply. In 1999, the Centers for Disease Control released a report calling fluoridation “one of the ten great public health achievements” of the century. By 2008, according to the CDC, 72.4 percent of the country had access to fluoridated water.
While San Francisco fluoridated its water supply by 1951, the rest of the state took far longer to consider it. Pollick said he thinks the delay is due to politics. “Health departments do not decide and government officials, including local health officers, have limited ability to influence decisions made by local or state elected representatives or the public in referenda,” Pollick said, “This may be more so in western states than back east or in the mid-west, where there has been a longer public health history and mindset.”
In 1995, California passed Assembly Bill 733 that, among other measures, said that any public water system with more than 10,000 service connections must fluoridate their water supply if funding can be found from a source other than the public water system itself. The bill, by not mandating private water companies fluoridate their supplies, basically gave California cities the option to ignore the legislation.
But why would cities, many of which are in Santa Clara county, want to ignore fluoridation? “I think it’s a little more complicated here than elsewhere,” Hanson said.
Much of the region’s water comes from the local wholesaler, the Santa Clara Valley Water District. The Water District is exempt from the law requiring fluoridation because it does not have 10,000 service connections; however, it does provide water to multiple water companies in the area that are not exempt. The water companies combine the water from the district with water from other sources (mostly wells) to provide water to different cities.
The city of Los Altos, with roughly 11,000 connections, recently began looking into fluoridating its system after a letter from a resident physician asked that they add it to the agenda. In Los Altos, 70 percent of the city’s water comes from the Santa Clara Valley Water District, and the other 30 percent from ground-water wells owned by California Water Service Company.
In a report, Sam Silva, Cal Water quality manager, told the Los Altos City Council that the cost of fluoridating would run from $4.5-9.6 million initially, as well as $837,000 each year to operate and maintain the system. Further cost analyses are still being done.
Jim Gustafson, city engineering manager for Los Altos, said that potential funding for fluoridation could come from a continuous grant—rare and difficult to get— or from a tax the city council placed on the ballot or through a referendum. However, he added, Los Altos is unlikely to make a move toward fluoridation without other cities in the region.
Mayor Pro Tem Valerie Carpenter, who did not offer an opinion, said in a study session on fluoridation in December, that a “regional solution, a regional examination of this issue makes the most sense to me, so I’m confident that the Santa Clara County Board of Supervisors under the guide of Supervisor Liz Kniss will thoroughly evaluate the pros and cons of this issue.”
“The county board of supervisors is holding a workshop for the county, I believe in March,” Carpenter added.
That’s where Hansen comes in. He has worked with Supervisor Kniss on her Healthcare Solutions Task Force, and since 2008, he has also been gathering a coalition of fluoridation supporters in the area including local dental societies, non-profit health groups and grassroots community organizations to show the Water District Board that the community at large wants fluoridation.
Still, there are vocal opponents. Since fluoridation was first put on the Los Altos council agenda, Gustafson said, supporters and fervent opponents have come to speak at each city council meeting. The most vehement opponents often associate themselves with the Fluoride Action Network, which claims that community water fluoridation is not only ineffective as an oral health treatment but also potentially harmful. One Hayward resident who claimed affiliation with the Fluoride Action Network at the Dec. 14 Los Altos hearing said emphatically, “It’s poison.”
“They are very vocal, but I don’t think there are numbers of them,” said Kathleen Cooper, executive director of the Santa Clara Dental Society.
Just this past January, the CDC lowered the recommended level of fluoride for drinking water from a range of 0.07-1.2 parts per million to just a set 0.07 ppm. The change has led to concern that children today, who are getting fluoride from multiple sources from toothpaste to juices, may be getting too much. That can cause an effect called fluorosis in young children with developing teeth, which generally gives tooth enamel a mottled look and in severe cases can cause pitting and staining.
To those who question fluoridation’s effectiveness or safety, Hansen replies with a steady voice:, “I’m compelled by the evidence and credibility of the pro-fluoride groups.”
The CDC, American Dental Association and the past five U.S. Surgeon Generals have endorsed the use of fluoride in public water.
Even if Hansen and the coalition can convince the Water District that the majority of the community wants fluoride, there is still the task of locating the money. In a state riddled with economic troubles, the millions of dollars in capital investment as well as sustaining funds for maintenance will be difficult to find.
Supervisor Kniss has said that she hopes to reach her goal of water fluoridation for Santa Clara County in five years. To make that goal a reality, even with fluoridation well-established in the rest of the country, lobbyists and organizations like Hansen and the HealthTrust have a lot of work to do.