The assertion is hard to ignore:

“There is a poison in the tap water.”

Those words and a picture of a faucet with a skull and crossbones were in a flyer about fluoride that Mt. Clemens officials found posted in the city during the debate over whether to continue adding fluoride to the city’s drinking water.

In a dramatic reversal of a public health initiative aimed at stopping tooth decay in 1951, city commissioners voted 6-0 last month to stop fluoridation.

The action, which city officials say would save more than $40,000 per year, comes as debate over fluoride’s benefits versus its possible adverse effects — ranging from spotted teeth to suspicions that it increases the risk of bone cancer — has gained new attention.

Other communities, such as Marcellus in southwest Michigan; Fairbanks, Alaska, and Calgary, Alberta, have also decided this year to stop fluoridating their water supplies. And the U.S. Department of Health and Human Services issued a preliminary recommendation in January that communities add fluoride on the low end of what had been the accepted range.

Prominent medical boards and agencies continue to tout fluoride as safe and essential to dental health. But others, like Paul Connett, executive director of the Fluoride Action Network, consider fluoride a danger to humans. He calls fluoridation “the most bizarre public health policy that’s ever been developed.”

Effectiveness of fluoridation debated

It was mostly about the money for Gary Blash.

Blash, a Mt. Clemens city commissioner, said his motivation in voting last month to end water fluoridation in the city was based on a desire to save more than $40,000 per year rather than on concerns about fluoride’s safety.

“It seemed like an expense we were incurring that wasn’t absolutely necessary anymore,” Blash said. “We’re not depriving anybody from fluoride. If they want it, it’s readily available.”

The prevalence of fluoride in toothpaste, processed foods and other products, including some bottled water, is one reason opponents say fluoride should be phased out of community water systems.

They say fluoride can also lead to health problems such as dental fluorosis, where teeth can develop spots or streaks and become pitted because of overexposure to fluoride. Research has shown fluorosis rates higher than 40% among some adolescents, although fluoride supporters say fluorosis, in many cases, might only be evident to a dentist. The Michigan Dental Association cited data showing “less than one-quarter of persons aged 6-49 had dental fluorosis.”

Opponents also point to studies showing that fluoride could weaken bones and increase the risk of a type of bone cancer. Last year, Time magazine listed fluoride as one of the Top 10 Common Household Toxins, and the New York State Coalition Opposed to Fluoridation has been promoting a study this month in a Spanish-language medical journal that links prolonged ingestion of fluoride to nervous system damage.

But supporters say the levels of fluoride added to drinking water are too low to cause health problems.

Thomas Kochheiser, spokesman for the Michigan Dental Association, said the relatively low level of fluoride added to drinking water makes it safe.

“Too much of a good thing can cause problems,” he acknowledged, noting that fluoride’s presence in toothpaste and other products does not negate the need to add it to water. “Tooth decay is preventable, and water fluoridation is a big part of that.”

A longtime tool

Fluoride has been embraced for decades by the American medical and dental establishment as an essential tool in the fight against tooth decay.

Organizations such as the American Dental Association and the U.S. Centers for Disease Control and Prevention tout the benefits of fluoridated water, where communities add a form of the chemical to drinking water. Fluoride does occur naturally in water, but the level is boosted to get to what is considered an optimal amount.

The U.S. Department of Health and Human Services earlier this year proposed lowering the recommended amount of fluoride to 0.7 milligrams per liter from a range of 0.7 to 1.2 milligrams per liter.

Although critics dispute the effectiveness of fluoridated water in fighting tooth decay — William Hirzy, an American University professor and former U.S. Environmental Protection Agency scientist, said it’s like swallowing sunscreen to prevent sunburn — the ADA says fluoridation reduces tooth decay by 20%-40%.

“Studies conducted throughout the past 65 years have consistently shown that fluoridation of community water supplies is safe and effective in preventing dental decay in both children and adults. Simply by drinking water, children and adults can benefit from fluoridation’s cavity protection whether they are at home, work or school,” according to an ADA statement.

The CDC notes that 72.4% of the U.S. population served by public water systems receives fluoridated water, and almost 74% of Michigan’s population receives fluoridated water. Debates about fluoridation have arisen in several Michigan cities in recent years. Port Huron and Grand Rapids opted to stick with fluoridation, while Mt. Pleasant lowered the amount of fluoride in its water and Marcellus and Mt. Clemens decided to stop fluoridating.

A quick Internet search reveals that fluoride has many opponents touting their own research — misinformation, according to fluoride supporters — that disputes fluoride’s cavity-fighting reputation and blames fluoride for a multitude of possible adverse health effects, particularly for young children. Ralph Nader, the prominent consumer activist, even issued a statement earlier this month saying, “It’s way overdue for this country to have an extended and open scientific and regulatory debate on fluoridation.”

Opponents are quick to note that a standard tube of toothpaste includes an ominous warning that children who swallow more than the amount needed for brushing should seek medical help.

In fact, the CDC recommends “that children under 6 who are using fluoride toothpaste should use a small, pea-sized amount on the brush, spit out the excess paste, and rinse well after brushing,” and children 2 and younger should use fluoride toothpaste only on the advice of a doctor or dentist.

The form of fluoride that is added to the Mt. Clemens water supply is hydrofluosilicic acid, and it is kept in a building that requires special ventilation. Once the tank that houses the fluoride is empty, the supply will not be replenished, said Chuck Bellmore, the city’s utilities director.

Bellmore said he has no opinion about fluoridated water, but notes that the end of fluoridation in Mt. Clemens will allow his staff to stop handling the hazardous substance that is added to the water supply from Lake St. Clair.

For Mike Beers, who started a Facebook page dedicated to ending fluoridation in Mt. Clemens, the City Commission’s decision was a relief. Beers said the possible health effects and the knowledge that the form of fluoride used in community water systems is often a byproduct of phosphate production cause him concern.

“I’m not really some hard-core activist,” he said. “I was trying to see who else agreed with me and go from there.”

Icing on the cake

Curt Ralstrom uses a cake analogy to describe how fluoride works to protect teeth against tooth decay.

Ralstrom, the president-elect of the Macomb County Dental Society, calls the fluoride in tap water the cake and the fluoride in toothpaste the cake’s icing.

“Fluoride, when you ingest it in the water, it gets incorporated into the enamel and it makes it more resistant to the acid breakdown,” he said. “Fluoride in toothpaste (helps) to re-mineralize the external layers of enamel that have been broken down by the acid from our diets.”

Count Ralstrom, a dentist with an office in Clinton Township, among those who support fluoride. He called Mt. Clemens’ decision to stop fluoridating its water “penny-wise but pound-foolish.”

According to the CDC, every $1 spent on water fluoridation saves $38 in treatment costs. Some proponents say the amount of savings is even higher, although opponents dispute that as well.

As Ralstrom points out, consuming fluoride through water requires no extra effort from an individual, meaning that anyone, regardless of their economic status or access to health care, can receive fluoride.

And that’s what bothers some opponents. Paul Connett, executive director of the Fluoride Action Network and a chemistry professor at St. Lawrence University in Canton, N.Y., said there’s no reasonable mechanism short of not drinking the water to limit intake.

“It’s a bad medical practice to put any medication in the drinking water because you can’t control it,” Connett said, noting that “it’s unethical because you’re forcing it on people who don’t want it.”

[See original article for photos, insets, and a Michigan map of fluoridating counties]

Fluoride pride

Grand Rapids holds a special place in the history of water fluoridation.

In January 1945 as part of a study, Grand Rapids became the first city in the world to fluoridate its water. The effects on dental health in Grand Rapids were considered so dramatic that Muskegon, which had been in the untreated control group, opted before the study was complete to begin fluoridation.

The interest in fluoridation studies was prompted by the prevalence of tooth decay in much of the U.S. prior to the end of World War II.

“I think the city and the community are very proud that we were the first to add fluoride,” said Joellen Thompson, Grand Rapids’ water system manager.

Thompson said the city plans to reduce the amount of fluoride in its water on Friday.