Santa Fe City Councilor Peter Ives spent “endless hours” in the dental chair before the age of 12 getting his cavities filled. His younger brother, on the other hand, didn’t get any cavities until he was 20. The difference? Although neither drank fluoridated water, his younger brother took fluoride tablets.
That personal experience is one of the reasons Ives believes the city should reconsider its recent decision to stop adding fluoride to drinking water, as it has done since 1955. The freshman councilor also points out that dentists and federal agencies say the practice improves public health.
Yet Ives might have an uphill battle. After more than an hour of public testimony earlier this month that included pleas from people who say drinking fluoridated water is actually bad for humans, he was the only councilor to vote against the plan. Now it appears councilors might reopen the debate because of a procedural error, but it’s not clear whether the outcome will change.
The city ended up talking about fluoride in the water this summer because the Centers for Disease Control and the Environmental Protection Agency announced last year that the recommendation for “optimal fluoridation” would likely decrease soon from a current range of .8 to 1.2 parts per million to a set level of .7 ppm.
What happened at the late-night public meeting July 11, however, was that instead of amending city rules to go along with anticipated federal recommendations, six city councilors ordered a complete halt to the practice of adding fluoride.
The day after the meeting, Ives asked the city attorney for an opinion about whether policymakers acted properly. On Friday, Attorney Geno Zamora recommended the council invalidate its previous action and start over because the public did not receive adequate notice that the city was considering ending fluoridation.
Another factor in the debate is that homes and businesses in Santa Fe get most of their drinking water from the Buckman Direct Diversion project, which the city only partly controls. That pipeline off the Rio Grande is owned jointly by the city and the county and overseen by a board comprising two city officials, two county officials and one citizen at-large member.
Whether Buckman will change its fluoridation practice soon is unknown, said Bob Mulvey, diversion project manager.
“Based on my reading of the [facility operating agreement], this should go to the board for approval. It would be wise to give the board the opportunity to vote on the issue,” he said. “I have confidence that we have some very good elected officials. They understand the fluoride issue and they understand the water system and they work well together. I think they are going to come to a resolution where there is not a conflict.”
The board’s next meeting is scheduled for August, but Mulvey said the issue probably won’t get discussed until September.
Heated hearing led to vote
Some of the testimony at the July 11 meeting sounded like it was coming straight out of Dr. Strangelove — the 1964 film parody of the Cold War. Director Stanley Kubrick’s jab at the arms race featured a rogue general who argued that fluoridation of the water supply was a communist plot to destroy “our precious bodily fluids.”
But to those residents who waited for the better part of the evening to make statements to elected officials, it was no joking matter. Emotions ran high. Many who asked the council to stop adding fluoride cited studies purporting to show risks in drinking fluoridated water. Others work in the field of alternative health care. They blame excess fluoride for health problems ranging from kidney failure to cancer and said they don’t want “mass medication.”
“We call it ‘fluoridegate,’ ” said one speaker “It’s like Watergate.”
“I am the grandmother of a perfectly normal child,” west-side resident Ann Galloway said, her voice level rising to a shout by the end of her two-minute testimony. “Her mother gave her a drink of the city water, and now that child is autistic.”
Another speaker held up a tube of Crest toothpaste and read from the label warning that anyone who accidentally swallows a pea-sized amount of the fluoridated substance should get medical attention. The next speaker argued that fluoridation of the water was a way for industry to dispose of a toxic chemical and that government had been swindled into doing it.
“The central issue here is about free choice, and right now adding fluoride to the water is not giving everyone free choice,” said another woman. “There are possibilities of looking at other options where they could have fluoride if they want to for their children that don’t involve everyone having to ingest it.”
On the other side of the debate were people who have worked as dentists for decades and share the perspective of organizations like the American Dental Association and the CDC. Many of them were incredulous as they left the council meeting earlier this month.
Dr. Kris Hendricks brought a laptop computer to the hearing so he could show policymakers what he routinely sees in his office — dental decay that is so severe that kids have to be hospitalized. His images showed swollen red mouths with tiny, jagged brown stumps where there should have been little white teeth on pink gums.
Hendricks said the fluoride levels recommended by the federal agencies for dental health don’t approach the danger zone.
“It’s true what people say, there is no point in ingesting fluoride,” he told elected officials. “But the topical effect of fluoride is totally proven, and you get that topical effect when the water washes over your teeth.”
In a later interview he said it’s important for the community to understand that every medicine has what’s known as a “therapeutic dose,” and for fluoride it’s around .7 ppm — the level the CDC recommends.
“Anything below that is ineffective. If you have .2 or .3, it doesn’t provide a therapeutic dose,” he said. “It’s not a high enough concentration to have a benefit to our teeth.”
Providing the right level of fluoride in city water is “a fantastic way” to make sure kids have enough, he said. Without city fluoridation, decay among low-income children in the city is likely to increase. The city’s water sources have a range of natural fluoride from .2 ppm to .5ppm — not enough to make a difference.
Hendricks noted that fluoride isn’t a silver bullet for preventing cavities. Diet and poor oral health are other reasons young children end up with severe tooth decay. If the city’s decision sticks, he said, it will mean parents have to take more responsibility for their children’s’ teeth by making sure they have fluoride toothpaste or mouth rinse and limiting sugar and carbohydrates, which are the food supply for bacteria in the mouth.
“Some of the safety nets that were in place won’t be there anymore,” he said.
Next steps unclear
The only other city in New Mexico that adds fluoride to drinking water is Farmington. The Albuquerque Bernalillo Water Authority decided last year to stop adding fluoride because of the new evaluation under way by the the EPA and CDC. Spokesman David Morris said the water supply there already has an average fluoride level of .7 ppm.
Most of the bigger communities in the state have the opposite problem: too much naturally-occurring fluoride. “We get concerned about the health effects when it gets too high,”said Andy Edmonson, technical services manager for the state Drinking Water Bureau.
Surface water, such as what flows down the Rio Grande and Santa Fe River, has less fluoride than groundwater, he said, so communities that rely primarily on wells usually have higher fluoride levels in their drinking water. Many of the 600 community water systems in New Mexico actually treat water to remove fluoride so it’s below what the state considers the maximum contamination level of 2 ppm, he said.
What will happen next in Santa Fe is unclear.
Not every councilor explained his or her July 11 vote. Calvert noted that most of the city water was used for purposes other than drinking, yet the city fluoridates all of the water. Diet and fluoride toothpaste give most people more than enough fluoride, he said.
Although Calvert said that cost was not a factor, he calculated that about $16 of the city’s $32,000 annual expenditure on fluoride paid for the intended purpose of oral health.
“I think our money would be better spent giving $32,000 to La Familia and have them treat some of the people and getting to the point of … the real reason why people have this [severe tooth decay]. Is it because of having or not having fluoride or is it because of lack of dental hygiene, or is it because of diet?”
Several councilors have said they have no intention of reversing their decision.
Councilor Chris Rivera, who works as director of a medical clinic, said in an interview this week that he voted to stop fluoridation because he wants people to have a choice rather than forcing them to use fluoride.
Mayor David Coss, who only votes in case of a tie, admonished other lawmakers after the vote, calling the July 11 decision “dramatic” because the public notice didn’t alert residents to the possibility that the council would vote to stop fluoridating Santa Fe’s drinking water.
How fluoride works to benefit oral health
According to the U.S. Centers for Disease Control and Prevention, fluoride works by stopping the tooth decay process. Tooth decay is caused by certain bacteria in the mouth that produce acid and remove minerals from the surface of the tooth. When fluoride washes over the tooth, it helps to remineralize the surface and halts the formation of cavities.
How much is too much?
The state Drinking Water Bureau says a concentration of 2 parts per million (the same as 2 milligrams per liter) is a dangerous level in water that humans plan to drink. Santa Fe’s city water supply has a naturally occurring fluoride level of up to 0.5 ppm.
Proposed recommendations from the federal government say “optimal fluoridation” is 0.7 ppm (the same as 0.7 milligrams per liter)