Some U.S. cities have added fluoride to water for 65 years, but Santa Clara County cities still debate

While San Francisco fluoridated its water supply by 1951, the rest of the state took far longer to consider it. Los Altos and neighboring cities are debating costs and benefits now.
Los Altos and other cities in Santa Clara County are considering whether to fluoridate their water. (Photo courtesy of Flickr user wwarby)

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, Hansen 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.”

Supervisor Kniss’ office has said the next discussion of the issue would be a workshop held by the water district in March.

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.

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5 Comments

  1. says: jwillie6

    There are many large scientific studies to show that that drinking fluoridated water has no effect on cavity reduction and to show that it causes cancer and other health problems. The best source for scientific information on fluoridation can be found here: (www.fluoridealert.org).

    If fluoride were “proven,” there should be evidence of its success in Kentucky, which has been 100% fluoridated for over 40 years. Kentucky, however, leads the nation in the number of dental cavities in children, and in the number of completely toothless adults, according to government records. The same ineffectiveness is evident in many states and cities.

    Most of Europe (16 countries) has considered and has rejected fluoridation and is 98% fluoride free. The WHO (United Nations) reports that they have a better tooth decay rate than any fluoridated country.
    If you want fluoride in your water, put it in your own glass of water; leave the rest of us out of it.

  2. Fluoridation is based on scientific fraud!

    Fluoridation has historically been “sold” to politicians and civic leaders by using photos of rampant Baby Bottle/Sippy Cup Tooth Decay (BBTD), a highly visible decay of the upper front teeth. The cause of the decay is high levels of strep mutan bacteria. Fluoridated water at 1 ppm does not kill this bacteria that, 1) colonize on tooth surfaces, 2) thrive and multiply on sugars, and 3) pass their acidic waste onto the dental enamel causing the damage we call tooth decay.

    50 percent of U.S. Head Start children have Baby Bottle/Sippy Cup tooth decay from high levels of strep mutans bacteria. A steady source of sugar is supplied to the bacteria by sipping fluids rather than drinking fluids from a cup. The bacteria’s acidic waste first ravages the primary teeth and then continues on to decay the permanent teeth.

    In January 2000, Dr. Kathleen Thiessen, Senior Risk Assessment Scientist at SENES Oak Ridge Inc. Center for Risk Analysis, reviewed the 1993-94 California Oral Health Needs Assessment for the City of Escondido (Keepers-of-the-Well.org, #17 Effectiveness) and stated in her critique:

    1) For preschool children, … any evaluation of the effectiveness of various measures (fluoridation) must control for the occurrence of BBTD and,

    2) Any study of the effectiveness of a particular measure (fluoridation) in preventing dental caries must control for the presence of dental sealants, or the results will be meaningless. and,

    3) In addition, if children with BBTD are thought to be more prone to developing caries in permanent teeth, then history of BBTD vs. caries incidence should be examined for both preschool and elementary children.

    The dental literature is clear that elementary school children with a history of BBTD are indeed more prone to decay in permanent teeth. Therefore, controlling or adjusting for history of BBTD in elementary school children should be the norm but is never done! By not adjusting for BBTD history and sealants, dental studies of school children can claim a (false) fluoridation benefit!
    _______________

    Examples from the dental literature:

    Auge, K. Denver Post Medical Writer. Doctors donate services to restore little girl’s smile. The Denver Post, April 13, 2004. (Note: Denver, CO has been fluoridated since 1954.)
    “Sippy cups are the worst invention in history. The problem is parents’ propensity to let toddlers bed down with the cups, filled with juice or milk. The result is a sort of sleep-over party for mouth bacteria,” said pediatric dentist Dr. Barbara Hymer as she applied $5,000 worth of silver caps onto a 6-year-old with decayed upper teeth. Dr. Brad Smith, a Denver pediatric dentist estimates that his practice treats up to 300 cases a year of what dentists call Early Childhood Caries. Last year, Children’s Hospital did 2,100 dental surgeries, many of which stemmed from the condition, Smith said, and
    it is especially pervasive among children in poor families.

    Shiboski CH et al. The Association of Early Childhood Caries and Race/Ethnicity Among California Preschool Children. J Pub Health Dent; Vol 63, No 1, Winter 2003.
    Among 2,520 children, the largest proportion with a history of falling asleep sipping milk/sweet substance was among Latinos/Hispanics (72% among Head Start and 65% among non-HS) and HS Asians (56%). Regarding the 30% and 33% resultant decay
    rates respectively; Our analysis did not appear to be affected by whether or not
    children lived in an area with fluoridated water.

    Barnes GP et al. Ethnicity, Location, Age, and Fluoridation Factors in Baby Bottle Tooth Decay and Caries Prevalence of Head Start Children. Public Health Reports; 107: 167-73, 1992.
    By either of the two criterion i.e., two of the four maxillary incisors or three of the four maxillary incisors, the rate for 5-year-olds was significantly higher than for 3-year-olds. Children attending centers showed no significant differences based on fluoride status for the total sample or other variables.

    Kelly M et al. The Prevalence of Baby Bottle Tooth Decay Among Two Native American Populations. J Pub Health Dent; 47:94-97, 1987.
    The prevalence of BBTD in the 18 communities of Head Start children ranged from 17 to 85 percent with a mean of 53%. The surveyed communities had a mixture of fluoridated and non fluoridated drinking water sources. Regardless of water fluoridation, the prevalence of BBTD remained high at all of the sites surveyed.

    “Fluoride primarily protects the smooth surfaces of teeth, and sealants protect the pits and fissures (grooves), mainly on the chewing surfaces of the back teeth. Although pit and fissure tooth surfaces only comprise about 15% of all permanent tooth surfaces, they were the site of 83% of tooth decay in U.S. children in 1986-87.”
    Selected Findings and Recommendations from the 1993/94 California Oral Health Needs Assessment.

    “Because the surface-specific analysis was used, we learned that almost 90 percent of the remaining decay is found in the pits and fissures (chewing surfaces) of children’s teeth; those surfaces that are not as affected by the protective benefit of fluoride.”
    Letter, August 8, 2000, from Jeffrey P. Koplan, M.D., M.P.H., CDC Atlanta GA.

    “Nearly 90 percent of cavities in school children occur in the surfaces of teeth with vulnerable pits and grooves, where fluoride is least effective.”
    Facts From National Institute of Dental Research. Marshall Independent Marshall, MN, 5/92.
    _______________________
    Maureen Jones, Archivist – Citizens for Safe Drinking Water – http://www.Keepers-of-the-Well.org
    maureenj@pacbell.net (408) 297-8487 Fluoride Action Network – http://www.FluorideAlert.org

  3. With cancer being the 2nd leading cause of death, I want to see it eradicated. I don’t know if this is completely possible, but we do have a place to start. We can learn and teach the signs and symptoms of cancer in order to achieve earlier diagnoses. Some cancers are curable if found soon enough. This is why I desire to teach the signs of cancer! Thank you for this site and please continue to teach!

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