The State College Borough Water Authority on Thursday voted to begin the process of removing fluoride from the water supply serving about 75,000 people, despite opposition from a number of local dentists, hygienists, health professionals and residents.
Serving State College Borough and parts of Benner, College, Ferguson, Harris and Patton townships, SCBWA began fluoridating its water as a dental health measure in 1954. But when fluoride began to become more difficult to get in 2019, the authority’s board formed an ad hoc subcommittee to examine whether the practice should continue.
After being slowed by the pandemic, the committee returned its report in May and recommended 2-1 to cease fluoridation, not because it questioned whether fluoride prevents cavities, but because of peer-reviewed studies that suggest possible adverse health effects, potential environmental contamination caused by wasted fluoride and concern about distributing to customers who have no choice.
Following a discussion in June that saw many proponents of keeping fluoridation, and some who opposed it, the full board voted 6-0 on Thursday to initiate the process to modify SCBWA’s permit with the Department of Environmental Protection so that it can stop injecting fluoride into the water supply.
The board’s seventh member, Bernard Hoffnar, who was in favor of keeping fluoride, resigned in the middle of the roll call vote.
“I think this is an unfortunate situation and I don’t want to be part of a group that in fact is going to hurt the health of the people we’re serving, so I resign,” Hoffnar said.
The subcommittee’s report, delivered in May by board Vice Chair Rachel Brennan, showed that while about two-thirds of the U.S. population drinks fluoridated water, only about 6% of people worldwide do. In western Europe, where most water supplies are not artificially fluoridated, tooth decay rates have declined over the past 50 years.
Topical fluoride, the report said, is as effective as fluoridated drinking water and the advent of fluoride toothpaste brought significant improvements in dental health.
The American Dental Association recommends that infants should have formula prepared with fluoride-free water to reduce the risk of fluorosis, which causes pitting and discoloration of teeth and can weaken bones at higher levels.
Some research, Brennan said, like a 2019 study published in the Journal of the American Medical Association, showed an association (though not causation) between higher fluoride consumption by pregnant mothers and lower IQs among their children.
“Those reports are cause for caution. It is our job as members of the water authority to do our due diligence in protection of the community,” Brennan said. “…We look to science to inform us. Back when fluoride was put into the water we didn’t have those studies on neurotoxicity. We didn’t have studies on adverse effects.”
Backed by statewide dental associations, proponents of keeping fluoride, however, said the committee ignored decades of evidence that fluoridated water is safe and effective. Some chided the board for not including dental and medical professionals in their review. (All of the board’s current members work in science or engineering fields, with each holding a doctorate or master’s degree, and they repeatedly stressed they only used peer-reviewed research in their review.)
“Community water fluoridation has been one of the biggest public health success stories over the last 60 to 70 years,” Dr. Matthew Kremser, a local pediatric dentist, said at the board’s meeting in June. “It’s safe, it’s inexpensive and it works. There’s seven decades worth of peer-reviewed research that supports those statements.”
Like Kresmer, other local dentists and hygienists repeatedly cited their own observations of pediatric patients who live in communities that fluoridate water and those who don’t.
“I have seen multiple children from communities that don’t and those that do,” Donna Murray, a local public health hygienist for a school district, said on Thursday. “There is a stark difference between the two. In many of these children, they don’t have access to fluoride.”
Sarah Goard, a public health hygienist for UPMC and president of the Pennsylvania Dental Hygiene Association, added that for some children, there simply is no choice.
“A lot of times it’s unfortunately not the choice of children to learn good oral health habits or make it to the dentist,” Goard said. “Our position within UPMC has been to help educate children, their parents and caregivers and kind of bridge the gap, bring mobile units to them. But really we’re just putting a minor dent in that and that’s not enough. …Removing the fluoride from the water would be detrimental to those who are most in need and really the community as a whole.”
Nearly 100% of patients at Centre Volunteers in Medicine, which provides medical and dental care for low-income individuals with no insurance, have cavities and need multiple appointments with long waits to address their tooth decay, Executive Director Cheryl White said in June.
“In many cases, fluoride in the water is the only type of dental prevention these individuals have,” White said. “This is critical to help strengthen teeth and prevent decay.”
State College dentist April Detar and Kremser both said that they see few if any cases of fluorosis in their practices. Removing fluoride from the water, Detar said, will only worsen a growing rise in tooth decay problems nationally.
“If we take fluoride out of the drinking water, you can expect your dentist to be much busier; you can expect your wait times to be a lot longer; and, most importantly, you can expect to pay for it,” Detar said in June.
Detar added that most people do not brush their teeth well enough for fluoride toothpaste to have the impact of regularly drinking fluoridated water.
Brennan said fluoride’s efficacy is not in question, but that the board was concerned about several health issues.
The fluoride is solely sourced from China, and how it is produced is unknown, she said. The authority does know that it contains heavy metals, though they are below action levels.
“We are adding other substances besides just fluoride ions into the water,” Brennan said.
SCBWA Executive Director Brian Heiser added that the fluoride no longer comes shipped in the appropriate containers and requires extra handling, exposing plant operators to potentially toxic dust inhalation. He has a “growing concern” about the ability to source fluoride and the quality of the product.
Board member Gary Petersen, who served on the ad-hoc committee, said fluoride is a byproduct of the phosphate fertilizer industry and is not pharmaceutical grade, so he is concerned about what else SCBWA may be putting in the water.
Only about .8% of the added fluoride is actually ingested by SCBWA consumers daily and the wasted fluoride is released into the environment, which Petersen said poses a danger to aquatic life, plants and soil.
But his biggest concern is what he termed a “social justice” issue.
“Our customers don’t have a freedom of choice,” Petersen said. “We’re forcing our customers to drink fluoridated water. As a member of this authority, I don’t think it’s the role of our authority to medicate customers.”
That was a stance echoed by board member Jason Grottini.
“There’s been a lot more research over the past decade that raises red flags for fluoridated water and that’s a big part of my decision here,” Grottini said. “I was on the fence about this two years ago when we started the committee and it’s taken a lot to get me over to one side of the aisle from the other. I don’t feel it’s our role to medicate people in this case with a substance that is being shown to be harmful in a lot of peer-reviewed literature.”
The decision about whether to fluoridate supplies shouldn’t be solely left to local water authorities, board member Nathaniel Warner said.
“I think there should be some national studies and recommendations to take this out of our hands,” he said.
Brennan and Grottini both said that, although SCBWA budgeted $70,000 for fluoride in 2019, the issue is not a financial one.
“I don’t view this as a cost-saving measure for the authority,” Grottini said. “I think cost is out of the equation here. Yes, we spend money on fluoridating the water, but I’d be just as happy to put that money into education and outreach…”
“In our community we have so much interest in protecting our youth, our children, our disadvantaged. That’s across the board,” Brennan said. “I would like us to consider as we go forward to think about what we can do as a community to improve the oral health of our children… Let’s invest in these oral health education programs with our youth, with the disadvantaged and really target the problem collectively together to find a better solution to this. Because what we’re seeing in the very most recent literature is cause for pause and I wouldn’t be ethically responsible if we didn’t bring this up to the board.”
Brennan, Grottini, Petersen, Warner, Emory Enscore and chair Jeff Kern voted in favor of the motion to cease fluoridation.
“No matter how the vote comes out, this is a vote because this board has done research and takes the commitment to the community and the community’s health and safe water to heart,” Kern said prior to the vote.
Hoffnar was the only member who opposed, but resigned instead of casting a vote.
“Our community deserves health care,” Hoffnar said earlier in the meeting. “…I feel it’s our responsibility to be responsible and if we stop fluoridation I believe it is not being responsible.”
Before the removal of fluoride can proceed, Kern said SCBWA will first have to modify its Department of Environmental Protection permit, which will require a public hearing and a submission of documentation to the state.