Portland's Decision to Forgo Fluoride May End Up Costing $11.3 Million a Year

National Journal

Oregon is ranked the fifth-worst state for tooth decay, and on Wednesday voters of Portland may have missed an opportunity to change that.

A measure to add fluoride to the city's tap water — which the city council approved in an unanimous decision — was opposed by 60 percent of voters. This rejection came despite an expensive public campaign on the side of pro-fluoride. Portland, a city known for its beat-to-our-own drummer culture (and the lampoon of said culture on Portlandia), has never fluoridated its water, a largely accepted practice in which two-thirds of America partakes. They may not want to join the bandwagon, but here's one clear reason why the municipality may come to regret the decision: The Centers for Disease Control and Prevention estimates that fluoridation saves a community of 20,000 or more about $19 per person, per year.

In a city the size of Portland, that's around $11.3 million a year. Of course, that's in terms of overall economic impact (the cost of trips to the dentist, fillings, etc.). The city itself will continue the savings (of around 50 cents a person) of not adding fluoride into the water.

As I reported in The Atlantic last year, fluoride opponents see it as an issue of personal choice. Fluoride is a drug, and a person should have the right to refuse it. (We have the right to refuse all sorts of things that benefit society as a whole — like vaccinations). And it is true that fluoride is a poison in high doses. But then, so is salt. The common accepted concentration of fluoride added in tap water is .7 parts per million (a part per million being 1 milligram of substance in a given liter). The Environmental Protection Agency considers a concentration of 4 parts per million to be the ceiling for safe fluoride concentrations. Although there has been research that suggests the ceiling be lowered to 2 ppm on the grounds that we also get fluoride from everyday foods and drinks. Even so, a review of the EPA's standards found the negative outcomes of 4ppm fluoridated water to be largely cosmetic. Too much fluoride causes teeth to be speckled and pitted. At very, very high concentrations — like 8 ppm, for 20 years or more — fluoride can make bones more brittle.

Fluoride supporters see it as an issue of public health. Having fluoride in the water has been shown to decrease the incidence of cavities, and helps narrow the dental-health gap between people who have access to good care and those who do not. Granted, as dental health care improved since the WWII era, benefits of fluoridated water on dental health have decreased.

Since fluoridation first appeared in the 1940s, it has been continually contested. Just over the course of the last two years, Pinellas County in Florida voted to stop fluoridation (backed by a tea-party sentiment of government overreach), just to resume it a year later (it had become a campaign issue in the November elections).

The fluoride debate is just the latest clash between science and politics. Even though CDC and the American Dental Association stand atop a mountain of scientific data in their support, detractors will always find holes to exploit. Good science leaves room for doubt.

"Fluoride has been scrutinized intensely," Stephen Levy, a dental researcher who has headed a two-decade study on the topic, told me last year. "EPA continues to look at it, the NIH, researchers, policy makers.... But for the individual who is arguing against it, we can never reach the burden of proof that they put out there."