In Lynden, faucets turn amid a water fluoridation debate - Salish Current
March 22, 2024
In Lynden, faucets turn amid a water fluoridation debate
Matt Benoit

Refreshing! But is it fluoridated? A movement is afoot in Lynden to end fluoride treatment of the town’s water supply, as officials and residents examine the evidence for and against the continued use of the mineral as a dental health strategy. (Sulfur, CC BY-SA 3.0, via Wikimedia Commons)

March 22, 2024
In Lynden, faucets turn amid a water fluoridation debate
Matt Benoit

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For nearly 80 years, cities and towns across the United States have added fluoride to their public water systems, with the intent of helping prevent tooth decay. 

The intended result for dental health was overwhelmingly positive, and is considered by the Centers for Disease Control and Prevention to be one of the greatest public health success stories of the 20th century. By 1992, 144 million Americans were receiving fluoridated water. By 2020, that number had climbed to over 208 million people, or roughly 75% of the country’s population. 

In Whatcom County, however, only one municipality currently fluoridates its water: Lynden. Anacortes is the only other public system with fluoridation in Whatcom, Skagit and San Juan counties. Per the Department of Health, 46% of Washington residents receive fluoride-treated drinking water.

Although Lynden has treated its water with fluoride for over 60 years, it is now seriously weighing the removal of fluoride from city taps after a group of citizens expressed worry over the mineral’s safety. Those concerns have spread to social media, where a private Facebook group, Lynden Against Its Toxic City Water, has 421 members as of publication. 

Scott Korthuis (LinkedIn)

Lynden Mayor Scott Korthuis told Salish Current that public hearings over the matter will be held during the city’s first May council meeting, with a council vote expected sometime between May and July. The matter has been broached at several city council meetings in the last six months, and Lynden City Hall is accepting written comment on the issue. 

Current state law, via 2023’s House Bill 1251, requires that public water systems must notify all customers at least 90 days prior to a vote or decision on fluoride usage, whether starting or stopping the practice.

There is also the possibility, however, of a compromise decision. 

Korthuis said that if the council rules in favor of continuing to fluoridate, the city could offer unfluoridated water, via bottled water, to any who want it, provided the number of people is small enough compared to the city’s overall customer base.

Past considerations

Korthuis said he’s personally heard more support for keeping fluoride than getting rid of it, and as a nearly lifelong resident, is generally in favor of keeping it. While concerns over fluoride have occasionally been brought to his attention, the amount of concern over fluoridation is currently more than he’s seen before as mayor. 

“This is the first time it really got traction,” he said. 

Gary Bode (Facebook)

Lynden council member Gary Bode, however, told Salish Current that the majority of people he’s spoken with don’t want fluoride in their water. Many of those who’ve moved here recently, he added, weren’t aware their water contained the additive until recently.

In Bellingham, fluoride has never been added to city drinking water, though the city considered it in 1997 and 2005. In 1997, a city council passed a resolution opposing water fluoridation, which was followed by a citywide voter initiative to add it in 2005. The initiative failed 53.03% to 46.97%. 

Eric Johnston, the city’s public works director, said there’s currently no plan to change the city’s long-standing policy. 

In Lynden, Bode said Lynden’s city charter prevents a citizen vote on the matter, leaving a majority vote of the city council to make any change. 

Current concerns

The current debate over fluoridation, Bode said, boils down to two things: concern over potential long-term consequences of fluoride ingestion and the individual freedom of informed consent.  

For decades, there wasn’t much information available to the general public to counter the idea that fluoridated water might have any non-dental health implications, Bode said. Treatments that initially were deemed safe until finally being revealed as otherwise, he added, have a long history. He cited thalidomide, which caused birth defects when taken by pregnant women in the four years it was approved in Europe for alleviating morning sickness discomfort; and DDT, an insecticide eventually linked to environmental degradation and possible carcinogenic effects in humans — banned in the U.S. in 1972 but still used in some locations to control mosquitoes that spread malaria. (Thalidomide has been approved for cancer and other treatments since 1998.)

“As responsible as we are for public health — out of abundance of caution — we probably should not be doing this anymore,” Bode said. “There are too many questions about this.”

Regarding individual choice, Bode mentioned informed consent for medical treatment being something that has not applied to additives for public water. He and others believe it should.

“Fluoride is not an essential nutrient for any reason whatsoever,” Bode contended. “It’s basically a medical process, and we don’t force medical processes. We shouldn’t in this day and age.” 

While Bode mentioned that lower, fluctuating levels of fluoride do naturally occur in water, the CDC notes that those levels are not enough to make a meaningful difference in dental health when consumed. Fluoride occurs naturally at dentally significant levels in several counties in Eastern Washington, the DoH has reported.

Facts and figures

The antifluoridation Facebook group’s “about” statement calls the fluoride in Lynden’s water “toxic,” identifying it as hydrofluorosilicic acid (HFS): a by-product from the phosphate fertilizer and aluminum industries. 

The CDC states that community water systems typically use one of three additives, including HFS. The additives are either added directly to water supplies or dissolved in solutions before being added. 

While Bode said there are numerous studies indicating additive fluoride may be toxic, the U.S. Environmental Protection Agency established an area of authority in 1979 regarding additives in public drinking water. While the EPA doesn’t regulate levels of these additives, it mandates that additives not exceed a “maximum containment level” (MCL) concentration. 

All fluoride additives must meet strict quality standards to assure public safety, the CDC states, including testing by the National Sanitation Foundation and the American National Standards Institute. Both entities are nonprofit, nongovernmental organizations. In addition, over 100 national and international organizations endorse water fluoridation, according to an August 2023 Washington State Department of Health statement.

According to the American Cancer Society, many population-based studies have neither established nor completely disproven that fluoridated water is linked to cancer, whether in laboratory mice or humans. 

Speaking with experts

Local health officials believe the concerns about fluoridated water are unfounded. 

Jonathan Henry, an associate dental director for Unity Care Northwest — a federally qualified health care center providing dental care to some of Whatcom County’s lowest-income patients — said the concentration of fluoride in drinking water is far less than the amount found in toothpaste, or that which is applied to teeth during dental cleanings. 

Those applications are topical versus ingested, but he said that still doesn’t mean ingested fluoride from water is likely to cause adverse health reactions, now or in the future. 

“When you add it to city water, they’re able to titrate the concentration so that it’s easily regulated and kept well within the safe limits,” he said. “There are no known chemical hazards with that product (at regulated concentrations).”

Fluoride in water, Henry added, provides a topical benefit every time a person takes a drink of water.

“Your mouth gets moistened, and the inside of your cheeks, and your tongue and your saliva, does bathe itself with that fluoride,” he said. “It’s just a much smaller dose, and you get it daily.”

Both bones and teeth absorb fluoride, Henry noted. Too much of it over long periods can cause what’s called “skeletal fluorosis,” concentrating excessively in bones and resulting in joint stiffness and pain. In an adult, however, about 50% of consumed fluoride will simply be urinated out, Henry said. Fluoride levels in most drinking water are well below the maximums that would cause fluorosis in healthy children and adults, he said. 

Amy Harley, a pediatrician and the co-health officer for the Whatcom County Health and Community Services Department, echoed the message that fluoridated water is safe. 

“To my knowledge, there’s not been consistent and convincing evidence that community water fluoridation causes any unwanted health effects other than dental fluorosis — the tooth staining that you can get when too much fluoride is consumed too early in tooth development,” she said. 

Many other products that are ingested — foods like milk and wheat — are fortified with vitamins for the good of public health, and fluoride is not much different. Just the same, she also notes that concerns about fluoride toxicity are not categorically untrue — if consumed in overly large quantities, any number of vitamins and minerals can have negative health consequences. 

When asked about where citizens might get concerning information about public health issues, Henry said he recommends getting advice from health experts you know and trust personally.

“It’s easy to go online and find lots of various claims and lots of information,” he said. “Ask anybody who’s a public health expert. All of us agree that fluoridation is a win-win for society. We’re just preventing disease and there’s no harm in it at all.” 

Harley agrees. 

“Information that’s complicated can be confusing,” she said. “It’s never wrong for people to ask questions, and we know that the intention is to protect the health of themselves, their children, and their community.”

Potential effects

If Lynden does stop fluoridation, the effects may range from negligible to negative on several fronts. 

Financially, Korthuis says ending fluoridation would save the city less than $25,000 a year — a very small percentage of its overall annual budget. 

A potentially more noticeable effect may show up in people’s teeth. Other cities that have rejected fluoride have seen a worsening in the dental health of its residents, especially among youth.

In 2007, Juneau, Alaska, voted to remove fluoride from the capital city’s water system. A decade later, a study by the University of Alaska Anchorage’s Jennifer Meyer — an assistant professor of health sciences — and Vasileios Margaritis, an oral health epidemiologist, examined the Medicaid dental claims records of 1,900 children in Juneau. 

The study found that children under six had more cavity-related procedures — about $300 more per year per child — after fluoride was removed from the city’s water supply. 

“The cost to have a fluoride management program to actually fluoridate the water is pennies by comparison to what it costs to treat a cavity,” Meyer told NPR in 2019

Henry echoed that sentiment.

“The downside to having to buy your own fluoride is that it’s expensive,” he said. “The downside to seeking dental care, in general, is expensive. Fluoride in the water in Lynden is one of the best ways we can reach (low-income) people.”

The  Windsor, Ontario, city council voted to remove fluoride in 2013, but wound up putting it back just five years later by the same margin it was originally repealed. 

At the end of the day, it appears the debate over fluoride in Lynden’s water system will ultimately end up being settled by whatever sources the city council trusts most. 

“(As) one of my city councilors said at one of the meetings, ‘go ahead and bring in your hand truck of information, and I’ll bring in my hand truck of information,'” Korthuis said. “There’s plenty of information, pro and con, on the internet or wherever you want to find it.”

— Reported by Matt Benoit

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