Pediatric dentist Michael Biermann was at work Wednesday when Portland, Ore., city council members voted to add fluoride to the city’s drinking water. But his thoughts immediately turned to two severe cases he treated recently.
One was a 13-month-old girl who had only four teeth -- but all four were decayed down to the gum line, Biermann said.
The other was a 3-year-old boy who had 21 teeth -- one more than normal -- all riddled with caries, or cavities.
“All 21 teeth were decayed. All 21 needed crowns,” recalled Biermann, 65, who devotes about 60 percent of his practice to treating children enrolled in Medicaid, the federal program that provides health care for the poor.
Fluoridating Portland’s water starting in March 2014, the timeline called for in the city’s new ordinance, could help prevent or slow such grim scenarios starting within six to nine months of implementation, he said.
“I think it’s fantastic,” said Biermann, who said he spends a day each week treating cases of severe decay.
Opponents of the measure, however, immediately vowed to collect the 20,000 signatures needed within 30 days to force a referendum to put fluoridation on hold.
“Fluoride is not a silver bullet,” said Kim Kaminski, executive director of Oregon Citizens for Safe Drinking Water. “We’re not going to put it in the water and then see a big drop in rampant decay.”
The fight in Portland -- where voters haven’t approved a fluoridation measure since 1978, when it was overturned before taking effect – mirrors controversy nationwide that continues, despite the fact that more than 200 million Americans drink fluoridated water and that it’s endorsed by nearly every major public health organization, including the Centers for Disease Control and the American Medical Association.
Until Wednesday, Portland was the largest city in the U.S. not to approve fluoridated water.
In Phoenix, city council members voted this week to continue adding fluoride to the drinking water, while Wichita, Kan., residents will vote in November whether to add the substance to that city’s water.
Proponents of fluoridation and dental experts say fluoride is key to fighting cavities and to protecting children in families who lack money or education to ensure dental care.
In Biermann's practice, he sees rampant decay caused by a combination of factors. Some parents may neglect their kids' dental hygiene, brushing teeth sporadically -- or not at all. Some may feed their kids poor diets, allowing constant consumption of sweets, soda and other sugary beverages. Others may think they're doing the right thing -- breast-feeding at will all night, for instance -- not realizing the effect it has on children's teeth. For those kids, fluoridated tap water might be the only protection they get, he said.
"It doesn't stop it, but it helps slow it down," he added.
Opponents of adding fluoride to public water supplies say that the substance is unsafe and that it amounts to mandatory medication without consent. They contend the science remains sketchy, despite more than 65 years of research and experience in the U.S. And, in Portland, Kaminski and others are outraged about what they see as an effort to fast-track fluoridation without allowing a public vote on an issue that has been defeated in the city -- and the state -- repeatedly.
The issue has raised some question at the federal level as well. In January 2011, two federal agencies, the Department of Health and Human Services and the Environmental Protection Agency, proposed to lower the maximum level of fluoride allowed in drinking water.
It was an attempt to strike a balance, a press release said at the time:
“Agencies working together to maintain benefits of preventing tooth decay while preventing excessive exposure.”
The plan called for limiting the amount of fluoride allowed in water to 0.7 milligrams of fluoride per liter of water. That was down from the recommended range of 0.7 milligrams per liter of water to 1.2 milligrams per liter of water.
Lowering the level would prevent tooth decay while preventing unwanted health effects, such as dental fluorosis, which causes lacy white markings or stains on the teeth of some people who get too much fluoride, the agencies said.
After a public comment period, final guidance on the recommendation – and a decision – was supposed to come in the spring 2011.
More than a year later, it’s not clear where the issue stands. Agency representatives did not immediately answer NBC News queries about the status of the proposal.
Biermann, however, said he’s encouraged by Portland’s latest action -- and hopeful that in a city and a state that has rejected fluoridation over and over, public opinion may have turned.
“This time it might stick,” he said.
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