Kentucky water plants would no longer have to add tooth-protecting fluoride to water, under bill approved by a committee

By Liam Niemeyer
Kentucky Lantern

Kentucky water utilities would no longer be required to add or adjust fluoride in tap-water supplies — a state requirement since the mid-20th century aimed at improving dental health — under a bill a legislative committee approved Thursday, Feb. 8.

House Bill 141 is the latest effort by Rep. Mark Hart, R-Falmouth, to remove the state requirement for water utilities serving populations larger than 3,000 to add or adjust fluoride levels in drinking water systems to “protect the dental health of the people served.”

Rep. Mark Hart, R-Falmouth
(Ky. Lantern photo by Liam Niemeyer)

Hart, a legislator since 2017, was the only sponsor of making drinking-water fluoridation optional when he filed the first such bill in 2018. The legislation has gained Republican co-sponsors as it has been filed several times over past legislative sessions.

The House State Government Committee heard the proposal for the first time Thursday and approved it 16-1. The bill now goes to the House floor for consideration.

Republicans who voted for the bill, and advocates for the legislation who joined Hart, characterized the bill as providing “local control” for utilities to choose whether or not to fluoridate their water. Those advocating the bill included representatives of Morehead’s municipal utility, Irvine’s municipal utility and the Grayson County Water District.

Some advocates for the bill questioned the efficacy of adding fluoride to tap water and its potential side effects.

“Honestly, it is forced medication,” said Rep. William Lawrence, R-Maysville, a co-sponsor of HB 141. “Whether you’re for or against fluoride, this bill has nothing to do with that. This is a local control — let the local water districts decide what’s best for their district.”

The Centers for Disease Control and Prevention considers community water fluoridation to be one of the 10 greatest public health achievements of the 20th century. The federal public-health agency also has found no “convincing scientific evidence” linking fluoridation to “any potential adverse health effect or systemic disorder.”

Groups representing dentists, oral-health advocates and the dental insurer Delta Dental strongly opposed the bill, saying it would increae tooth decay, particularly among children. Kentucky already ranks among the highest for the number of adults with no teeth.

“We have reached the point where it’s not about the science, it’s about the emotion,” Stephen Robertson, executive director of the Kentucky Dental Association, told the Lantern after the committee approved the bill. “No matter what your position is, you can find something out there that’s going to validate your position.”

Jack Kall, a Louisville dentist and supporter of the bill, showed lawmakers cited graphs from a 2016 magazine article by the Harvard T.H. Chan School of Public Health that questioned the efficacy and safety of fluoridation. That article was strongly criticized by the American Dental Association, saying it relied on a report that was a “biased misinterpretation,” and the dean of the Harvard School of Dental Medicine at the time called for the article to be rescinded.

Kall, citing the graphs, asserted that countries that don’t fluoridate water have had a similar decline in tooth-decay rates as countries that do. He told the Lantern that fluoride can lower intelligence in children; a federal court case is litigating whether the mineral has an effect on brain development.

“It’s a hot topic and science continues to evolve,” Kall said. “We should constantly be reviewing things.”

Robertson said there are studies regarding fluoride that need to be verified and that improvements in nutrition and personal dental hygiene also could improve dental health in Kentucky. But fluoride in drinking water, he said, is a “program that works.” He asked, “Are we willing to take the risk of removing fluoride and seeing what happens?”

FDA wants to reduce standard for fluoride in public drinking water

Lowering the amount of fluoride in drinking water, as proposed in January by the Food and Drug Administration, will increase medical expenses and harm the poor and the poorly educated the most, a mother writes in an op-ed piece in the New York Times.

Jane E. Brody delves into the concept of fluoridation, pointing out its benefits. "In the early years, rates of tooth decay among the young dropped by 60 percent in communities that adopted fluoridation," she writes. "Every $1 invested in fluoridation saves approximately $38 in dental treatment costs."

Though fluoride was initially thought to become incorporated into developing teeth, it was later found that its benefit is topical, meaning it works on teeth already formed. "Fluoride, which is present in saliva and concentrates in dental plaque, inhibits the action of acid on tooth minerals," she writes. "It also promotes remineralization by sticking to tooth surfaces, where it attracts calcium ions present in saliva."

Still, there remains controversy about whether or not fluoride is safe, with the substance being accused of causing everything from heart disease to Alzheimer's disease. "None of these supposed risks has ever been established in scientifically valid studies," Brody writes. "The only proven risk, a condition called fluorosis, which results in white and sometimes brownish markings on the teeth from too much fluoride, rarely results from a normal intake of fluoridated water."

Since fluoride is also available in other substances, like toothpaste, the FDA proposed reducing the amount of fluoride in public drinking water to 0.7 milligrams per liter, from a range from 0.7 to 1.2 milligrams. Brody feels the move is a mistake: "Fluoridation confers the greatest benefit to those who need it most: the poor and poorly educated and those with limited access to regular dental care," she writes. "In the years ahead, removal of fluoride from drinking water will almost certainly cost taxpayers millions of dollars in increased Medicaid expenditures." (Read more)

In Kentucky, there is 100 percent fluoridation in public drinking water systems, though perhaps half a million residents get their water from wells, springs or cisterns.