Union County commissioners could ban fluoride from water supply. What you need to know.

A water treatment plant in Union County could be prohibited from adding fluoride to its water supply after the Board of County Commissioners failed to come to a unanimous vote Monday evening.

The board voted 3-2 on an amendment that would prohibit the fluoridation of water at treatment plants owned and operated by Union County. Commissioner Richard Helms and Chairman J.R. Rowell opposed the amendment.

In a recording of the meeting, County Manager Brian Matthews said the ban, which has not taken effect yet, would only apply to the newly constructed Yadkin River Water Treatment plant.

Nearly two-thirds of the county’s water customers are in the Catawba River Basin, he said, which is supplied by Lancaster Water and Sewer District. The county owns the facility, but does not maintain or control the facility.

At the meeting, Union County residents, as well as dental experts stated their cases to the commissioners, urging them to vote one way or the other.

While dental experts and some residents pointed to the health benefits for teeth from adding fluoride to water and urged the board to vote down the amendment, other residents pushed back.

Residents urging the board to vote for the amendment brought up health concerns, arguing it violated their medical freedom and took away their ability to choose.

Vice Chairman Brian Helms, along with commissioners Melissa Merrell and David Williams, voted in favor. Helms said the issue wasn’t whether fluoride is good or bad, but rather, “if the Union County Board has the authority to forcibly medicate its residents without consent.”

The debate about adding fluoride to water isn’t new to Union County, according to the Enquirer Journal. Some in the community previously have raised concerns.

The Centers for Disease Control and Prevention’s website, which tracks which towns around the country add fluoride to its water supplies, shows Franklin and Sparta are two North Carolina towns that do not.

The debate has been happening everywhere for decades.

What’s the deal with fluoride in water supplies?

According to the CDCwebsite, fluoride has been added to water supplies in the U.S. since the 1940s, after studies found that children had less tooth decay if they drank water with naturally high levels of fluoride.

During that time, it said, most children and adults suffered from issues like toothaches and tooth decay, often losing teeth.

After government officials began adding fluoride to water, the country saw a “dramatic decline in tooth decay over the past 75 years,” leading the CDC to name it one of the 10 “great public health achievements of the 20th century.”

The CDC now says, drinking fluoridated water reduces tooth decay by about 25% in children and adults.

North Carolina has been supporting fluoridating water for over 70 years, said a statement published in 2014 by Robin Gary Cummings, then acting state health director. Charlotte began fluoridating its water supply in 1949, the statement also said.

Why is it controversial?

While groups, such as the American Dental Association, the American Medical Association, CDC, WHO and the American Academy of Pediatrics endorse fluoridated water, other groups disagree.

The Fluoride Action Network, which provides information about why fluoridated water can cause harm publishes “toolkits” on its website to help people push for an end to fluoridated water supplies, and links to research they say shows the negative effects of fluoridated water.

Its website also says the organization “seeks to broaden awareness among citizens, scientists, and policymakers on the toxicity of fluoride compounds.”

While the concerns raised during Monday’s meeting focused on medical freedom and citizens’ ability to “consent” whether they want to consume fluoridate water, another concern focused on the potential health impacts.

One public speaker said during the meeting that banning fluoride from water supplies would be reversing “60-plus years of poisoning the public.”

Are there adverse health impacts?

While the debate about fluoridated water has hinged on whether it is harmful, the World Health Organization (WHO) also said that high doses of fluoride can actually be damaging to teeth.

A more prevalent concern, according to the American Cancer Society, is if adding fluoride to water could lead to bone cancer.

The organization pointed to a common theory on its website that fluoride might cause cells in growth plates — areas where osteosarcomas typically develop — to become cancerous because fluoride tends to collect in those areas.

Among groups doing research, the general consensus is “that there is no strong evidence” linking the two issues. Several of the reviews “noted that further studies are needed to help clarify a possible link.”

There also have been debates whether fluoridated water is harmful to pregnant women, and if high levels of fluoride in water leads to lower IQs in children — a topic also touched upon during Monday’s meeting.

What is being said about pregnant women and children?

The CDC said data from a national survey showed tooth decay prevention can be maintained at 0.7 milligrams of fluoride per liter of drinking water — the recommended amount. That number replaced the previously recommended range of 0.7 to 1.2 milligrams per liter, the CDC said.

But recent studies, including a Canadian study published in JAMA pediatrics, a medical journal, in 2019, concluded pregnant mothers exposed to higher levels of fluoride led to children aged 3 to 4 years old having lower IQ scores.

“These findings indicate the possible need to reduce fluoride intake during pregnancy,” the study said.

And groups like the Fluoride Action Network have defended the study as proof that there should be “a moratorium on fluoridation until the matter has been resolved.”

The study’s author, Christine Till, told Buzzfeed News in 2019 that she thought “this message could be easily misconstrued as us saying don’t drink fluoridated water — we’re not saying that.”

Since the publication, the topic has landed in court where experts have argued whether the Environmental Protection Agency should ban fluoridated water to avoid potentially harming children.

. In a statement released in 2019, shortly after the study’s publication, the ADA said it would “continue to evaluate the validity of emerging evidence and research to support the advancement of the health of the public.”

The statement also said the ADA remained “committed” to adding fluoride to water supplies, as it is “the single most effective public health measure to help prevent tooth decay.”

What about the health benefits?

Dentists from Union County, as well as other areas of North Carolina, including a professor of dentistry from East Carolina University, attended Monday’s meeting to plead with the commissioners to continue fluoridating water.

They highlighted the health benefits, like preventing tooth decay and cavities, as well as the potential financial impact removing fluoride from water supplies could have on residents.

A pediatric dentist speaking to the board said that a large portion of the population she treats has Medicaid, which has been “well-documented” to be at high risk for tooth decay.

It “oftentimes put their systemic health at-risk,” she said. Additionally, the pediatric dentist said, removing a passive preventive measure, like community water fluoridation will have “astronomic financial results on the taxpayer.”

The North Carolina Department of Health and Human Services estimates on its website that for every dollar spent on community water fluoridation, residents save approximately $38 in treatment costs for tooth decay. The average cost of fluoridation is about $0.50 cents per person, per year, it said.

“Fluoridation is the most cost-effective method of preventing tooth decay,” the NCDHHS’s website said. “It is also a very equitable method of disease prevention -- all people benefit regardless of their incomes, educational levels, ages, or ability to get dental treatment.”

The CDC also pointed to health benefits like strengthening children’s permanent teeth that develop under the gums, while also supporting adult’s teeth enamel. Fluoridated water, the CDC said, also helps prevent fewer and less severe cavities, less need for fillings and removing teeth and less pain from tooth decay.

What happens next?

Because the board failed to come to a unanimous decision on Monday, it will need to vote again in two weeks.

The next meeting will be held on Monday, Feb. 19.