When the city of Bisbee decided to remove fluoride from its water supply earlier this year, the vote was unanimous but there was no input from any public health entity.
Public health officials say residents in Bisbee, a Southern Arizona city of about 5,000 people, should be aware they are more susceptible to cavities now that fluoride levels, at naturally occurring levels of less than 0.2 milligrams per liter are now well below the federally recommended level of 0.7 milligrams per liter.
Bisbeeโs decision is counter to a national trend, where more communities are opting to fluoridate their water supplies, said Kevin Earle, executive director of the Arizona Dental Association.
Earleโs organization sent a letter to Bisbee council members in the wake of its February decision, requesting it to reconsider the decision, but the response has been โcrickets,โ he said.
โIt is definitely not a reasoned and rational public policy decision. Ultimately we believe it is going to hurt children,โ Earle said.
Officials in Bisbee stand by their decision, which received unanimous support from City Council members and loud cheers from some of those in attendance when it passed.
During discussion before the vote, some council members said that while fluoride may have at one time been necessary in community water supplies, products like fluoridated mouthwash, toothpaste and foods processed with fluoride mean itโs no longer necessary.
Itโs true that fluoride is more readily available now, which is why the U.S. Public Health Service lowered its recommended levels of fluoride in drinking water in 2015, for the first time in 53 years, to the current 0.7 milligrams per liter.
However, there is still evidence that fluoridated water strengthens teeth, many public health officials say.
โWater fluoridation is named in the top 10 public health interventions of the 20th century and has been remarkably successful at improving the oral health of folks all over the world,โ said Will Humble, executive director of the Arizona Public Health Association.
โItโs just sad when you see a community purposely decide to reduce the oral health of their residents, but we live in a democracy and I guess thatโs what they want.โ
Tucson doesnโt add flouride, either
The Chicago-based nonprofit Oral Health America says that in 2017 nearly 73 percent of Americans were served by a fluoridated community water supply โ thatโs an increase of 2.2 million Americans over 2016.
In Arizona 57.8 percent of the population are served by a fluoridated water supply, the Oral Health Project found.
In April, Oral Health America released its annual โA State of Decayโ report card on oral health for people ages 65 and older. Arizona ranked 38th out of 50 states overall. One of the reportโs recommendations for improving oral health among older adults is to sustain or expand community water fluoridation.
Arizona cities with water fluoridation include Phoenix, Glendale, Tempe, Chandler, El Mirage, Mesa and Yuma, the Arizona Department of Health Services says. Tucson and Flagstaff do not fluoridate their water supplies.
The Tucson City Council in 1992 voted to fluoridate the community water supply here in conjunction with the introduction of Central Arizona Project water, but the implementation never happened because of technical problems.
Parents in Bisbee should let their childโs pediatrician and dental provider know the water is not fluoridated, as some providers might recommend a fluoride supplement, said Carry Langley, director of Cochise County Health and Social Services.
โWe didnโt weigh in on the decision, nor were we notified of how this happened,โ Langley said of the Feb. 6 vote.
โWe heard about it from the Arizona Public Health Association ... I donโt know what happened or what informed their decision.
โSome fluoride naturally occurs in water but itโs usually not enough to prevent cavities.โ
โProgressive cityโ
Minutes from the meeting show that Councilman Gabe Lindstrom introduced the amendment to the city code that directed Bisbee Water to stop adding fluoride to the city water supply.
Lindstrom explained that he had researched fluoride and saw studies that said fluoride doesnโt add to water safety, and that itโs potentially harmful to ingest, according to an audio recording of the meeting posted on the city of Bisbeeโs website. He also told the council heโs worried about fluorideโs long-term effects.
โI recently received an email from someone who said as a council we might not be qualified to make a scientific decision because we are not scientists.
โBut you know, we could use that logic for everything โ accounts payable, weโre not financial experts. ... I do work in the health-care industry I am a health provider,โ said Lindstrom, whose Facebook page identifies him as a nurse practitioner.
โLetโs be the progressive city that everyone wants us to be,โ he said during the meeting, urging an immediate vote that night.
Lindstrom referred requests for comment to Bisbee Mayor David M. Smith, who confirmed with the Star last week that fluoride was taken out of the cityโs water a month after the vote.
Smith said public health officials did have a chance to give input about the benefits of fluoride in 2016.
At that time the council considered removing fluoride altogether but instead opted to reduce the amount of fluoride from 1.0 milligrams per liter down to the federally recommended level of 0.7 milligrams per liter. Council members would have remembered that testimony, Smith said.
Smith also said there is a lot of publicly available information about water fluoridation โ both good and bad, and much of it conflicting.
But he hasnโt heard negative feedback from Bisbee residents about removing the fluoride and heโs satisfied with the councilโs decision.
โI am unaware of any controversy since the vote,โ he said.
โThe council works off the wishes of the constituents of Bisbee. ... I have not received one letter saying letโs keep fluoridating the water.โ
Smith said many in the community are worried about dental fluorosis, which is a condition that results from consuming too much fluoride and can result in mottled teeth.
Most dental fluorosis in the U.S. is mild and appears as white spots on the teeth, the U.S. Centers for Disease Control and Prevention says, and the condition does not affect dental function.
Moderate and severe forms of dental fluorosis, however cause more extensive enamel changes and can cause pitting in the teeth. The severe form rarely occurs in communities where fluoride in the water is less than 2.0 milligrams per liter โ nearly three times the federally recommended level, the CDC says.
The vote in favor of removing fluoride from the Bisbee water supply was unanimous.
Smith said as far as heโs concerned itโs a done deal, but that heโs always willing to listen to new scientific information.
Bisbee is not the only jurisdiction that has chosen to remove fluoride from its water. In 2011, Pinellas County in Florida voted in favor of de-fluoridating its water supply, but then reversed the decision and began adding fluoride again in 2013.
โIn recent years thereโs been more adding than taking away,โ Earle said. โWe would be happy to bring in nationally recognized experts and we offered that. We also sent them a fluoridation facts book, which has the real science.โ
Community water fluoridation is a โfundamental of oral health,โ said Alicia Thompson, coordinator of the Southern Arizona Oral Health Coalition.
Thompson said her organization reached out to Bisbee city officials after this yearโs fluoride vote, too. She cited data that shows communities that reverse water fluoridation also show a decline in oral health.
โWe immediately sent something to them and didnโt hear back,โ she said.
