SHERIDAN — People talked, petitions circulated and the newspaper became a battleground for letters to the editor.

Those in favor of adding fluoride to the water supply felt it was a certain way to prevent tooth decay. Those against insisted that fluoride in the water would lead to cancer, stomach ulcers and more.

The issue was taken to a vote, and just five years after Sheridan began adding fluoride to its water, it stopped.

The people had spoken.

“They put on a real citizen push, and that stopped fluoridation,” Dr. Sy Thickman said.

Thickman, now 90, was 31 at the time. He had moved to Sheridan a year before to begin his practice and remembers the events of 1954 well. He was in favor of fluoridation, but U.S. District Attorney John Raper and Dr. John Pratt, a respected physician, were against it and made enough waves to get it removed from Sheridan’s water supply.

Nearly 60 years later, people are talking, a petition is circulating and it appears the subject of water fluoridation is as controversial as ever.

Last month, the city of Sheridan began conventional upgrades to the Sheridan and Big Goose Water Treatment plants as required to meet new Environmental Protection Agency regulations. Included in the upgrades is the addition of water fluoridation equipment, a process set in motion by City Council nearly three years ago.

As the upgrades have been made, a group called Clean Water Sheridan has circulated a petition asking City Council to reverse the decision to add fluoride to Sheridan’s water, saying medication should be a personal decision. The petition currently has more than 800 signatures.

On the other side of the issue, many dental and health professionals are celebrating what they call a necessary step in public health policy.

A matter of choice

The most recent decision to add fluoride to Sheridan’s water supply came in December 2010 after the City Council received a ­­­­­­petition signed by more than 230 health and dental professionals asking the city to consider water fluoridation to help with widespread dental decay, Mayor Dave Kinskey said.

In 2010, nearly 74 percent of the U.S. population had access to fluoridated tap water, according to the Centers for Disease Control and Prevention.

“At that meeting we had received petitions both for and against, and letters, and cards, and emails both for and against. The Council and I listened and studied carefully, heard the objections, vetted all those objections through the medical professionals,”?Kinskey said. “It all boils down to this is just a simple public health measure.”

The fact that water fluoridation is a “simple public health measure” seems to be the core of the problem. Several public health measures — including vaccinations and giving condoms and other forms of birth control to students — are also hotly contested.

People for fluoridation say that matters of public health policy should be decided by professionals, while those against believe that fluoride use should be a personal choice.

Janet Berry, community oral health coordinator for the Wyoming Department of Health, said people need to trust that officials have the public’s best interest in mind.

“We need to entrust that the CDC and our public health officials have made the best choice for this community because it isn’t just a cavity; it’s a public health issue,” Berry said.

Sherrie Hotchkiss, a retired dental hygienist, agreed.

“Traditionally, public health policy is not policy that is voted on by the public. It’s set by public officials because it takes a more global perspective than looking at ‘What do I want?’ It’s set for the good of the community,” Hotchkiss said.

Petition supporters still believe there should have been more public input and a public vote since they view fluoridation as a form of mass medication.

“Fluoride treats your body and my body,” petitioner Erin Adams said while gathering signatures at the farmers market Thursday. “No one would give someone a prescription and say, ‘Take this as often as you want to and give it to your kids and friends, as well.’”

Adams noted that many petition signers said they think fluoridation was approved in a sneaky way, limiting public input to one public hearing at a City Council meeting five days before Christmas.

Resolution 60-10, the first action on fluoridation adopted by City Council Dec. 20, 2010, allowed water treatment staff to monitor fluoride levels and directed the public works department to incorporate fluoridation equipment into its current and future budgets.

“As I understand the resolution, City Council directed the Public Works Department to figure out the costs and the logistics of installing a fluoride system, which they did…City Council thereafter approved the budget, which included the approval of the costs to upgrades to provide the fluoride feed system,” City Attorney Greg Von Krosigk wrote in an email to The Sheridan Press when asked to interpret whether Resolution 60-10, itself, allowed the city to fluoridate the water.

According to minutes from the April 15, 2013, City Council meeting, the Council approved a bid award for $5 million to complete water treatment plant upgrades, including the addition of fluoridation equipment, in its consent agenda.

Kinskey did note that those who do not wish to drink fluoridated water have a choice to opt out by purchasing a reverse osmosis filter system and even mentioned that City Hall is considering buying filters in bulk and offering them at cost to anyone interested.

A matter of health

Health and dental officials say that the seriousness of the tooth decay problem in Sheridan County means that brushing, flossing and even weekly fluoride swishing programs in area schools are not enough to prevent dental disease.

“I don’t think that people realize how serious a problem decay is in this county. I’m hearing people say, ‘Just take a tablet; or use fluoride rinse; brush your teeth.’ Those things are not enough, and that’s why we pursued this two years ago. Dental decay is a progressive disease, and it affects your overall health,” Berry said.

“Eighty-six percent of children K through five in Sheridan County schools, districts 1 and 2, have had at least one cavity,” she added.

According to the National Institute of Dental and Craniofacial Research, 21 percent of children ages 6 to 11 nationwide have had dental cavities in their permanent teeth.

Berry said the best fluoride treatment is low dose and frequent — such as with fluoridated water — because it binds to the surface of the teeth throughout the day and gets into the bloodstream, which is crucial for children ages birth to 12 years because it makes permanent teeth harder as they form beneath the gums.

Hotchkiss described fluoridated water as a continual bathing of fluoride on the teeth since it gets into saliva. She said it isn’t possible to get too much topical fluoride after the age of 12 when permanent teeth are grown, and that the mixture of systemic (ingested) and topical fluoride is optimal for healthy teeth.

She also noted that fluorosis — the discoloration of teeth ranging from mild white streaks to dark brown spots or even pits that is caused by too much fluoride — only occurs in children. Dentists do warn that fluoride supplements should be stopped once water fluoridation begins, but normal brushing and rinsing can continue.

Kinskey compared fluoridation to the addition of chlorine to the water, which pulls impurities out of the water and prevents diseases like cholera and dysentery.

“Some people say, ‘Well, my dental health is between me and my dentist.’ Well maybe your dysentery is between you and your doctor, and your cholera should be between you and your doctor, and your typhoid fever is between you and your doctor,” Kinskey said.

Some opponents of fluoridation admit that it seems to aid in prevention of tooth decay, but they wonder at what cost to other body systems.

“Sometimes drugs have their place, but it’s the overmedication that’s the problem,” said Dr. Nate Heines, a local chiropractor.

Heines studied fluorine in college and found that it is one of the most reactive elements in the periodic table, sometimes causing bad reactions at the cellular level.

Adams noted that fluoride tablets are a prescription medication that are listed as an unapproved drug by the Food and Drug Administration. She also worried about people consuming so many sources of fluoride since it is found in soda, tea, wine, beer and several foods in addition to toothpaste and other dental products.

Several studies have shown links between high doses of fluoride (above 4 parts per million, which is the maximum contaminant level set by the EPA) and bone disease and fractures. Studies of the relation between fluoride and cancer, development disabilities and kidney failure have been conducted but are not considered definitive.

“We need to apply the precautionary principle,” Adams said. “If there’s any doubt, and in my mind there is, we need to avoid medicating the whole population.”

A matter of research

Type “fluoridation” into an internet search engine and be ready to be bombarded by more than one million hits. Even if only scientifically valid studies are considered, there is a lot of information about fluoridation, and people on both sides of the issue use that fact in their arguments.

Berry and Hotchkiss mentioned that more than 100 national and international organizations endorse water fluoridation as a public health benefit, with the CDC proclaiming it one of 10 great public health achievements in the 20th century.

“It’s been studied for 65 years at the recommended levels not shown to cause any ill effects, at the optimum levels,” Hotchkiss said.

However, Adams noted that the American Dental Association’s “Fluoridation Facts” handbook used by health and government officials to dispel any objections to fluoride is more than eight years old and recent research has indicated that recommended fluoride levels should be lower than previously thought.

The U.S. Department of Health recently lowered the recommended level of fluoridation in drinking water from 1 part per million to 0.7 parts per million, partially due to research indicating that dental fluorosis in children ages 12-15 increased from 23 percent in 1987 to 41 percent in 2004. Likewise, the EPA is considering lowering its maximum contaminant level for fluoride from 4 to 2 parts per million.

Adams and other opponents to fluoridation feel that more current research is needed, especially in specific areas such as its effects on brain development, infant health and kidney health.

Lynnet Bede, clinical coordinator of the Watt Dialysis Center at Sheridan Memorial Hospital and a certified nephrology nurse, said that dialysis centers filter water used to clean blood in dialysis treatments so Sheridan’s approaching water fluoridation will not be a concern for dialysis patients.

However, Bede is concerned about the possible effects of drinking fluoridated water on people with compromised renal function including those with kidney failure, high blood pressure and diabetes.

“I’ve perused a lot of articles. The truth of the matter is there’s not enough research and studies done to determine whether fluoridated water is a detriment to people with kidney failure or compromised kidneys,”?Bede said.

“The kidneys do filter out fluoride, so common sense tells you that if a kidney is compromised, it can’t filter as well, which could lead to some degree of toxicity,”?she added.

Looking ahead

Conventional upgrades to the Sheridan and Big Goose Water Treatment plants are scheduled to be complete in summer 2014. The upgrades will include installation of fluoride holding tanks and distribution systems, Water Treatment Superintendent Tom Manolis said.

Manolis said he is not sure where Sheridan will purchase its fluoride but said it will be in a liquid chemical form as opposed to powder.

“Any product used has to meet American Water Works Association standards,”?Manolis said. “In order to get their stamp of approval, it can’t contain mineral or organic substances in quantities capable of producing harm.”

Berry and Hotchkiss said they are looking forward to seeing less dental decay in Sheridan County, noting that in 2012-2013 taxpayers paid $816,000 for dental Medicaid because of the decay problem.

Opponents will continue to gather signatures on their petition asking City Council to stop planning for the fluoridation of Sheridan’s water.

The city has no legal obligation to deal with the petition, but Adams hopes there will be strength in numbers. In order for water fluoridation to be reconsidered by City Council, a councilor would have to make a motion and another councilor would have to second it to bring the petition onto the table, Kinskey said.

In the meantime, arguments for and against water fluoridation will continue to fly and history may or may not repeat itself.