Water fluoridation returns to the news, with Bremerton’s history of debate a backdrop

In April 1997, the Bremerton City Council approved adding fluoride to the city’s water system after a group of residents identified children’s dental health as a major issue there. 

Port Orchard, Poulsbo and Bainbridge Island and many other American water providers started fluoridating their water over the previous half-century. Extensive evidence showed it reduced cavities and tooth decay. At an annual cost of less than $2 per customer, the decision was regarded as a common-sense and cost-effective measure. 

But before it could begin, an anti-fluoride citizen group petitioned the city council to put the decision before voters. During a special election nearly two years later, residents rejected the proposal and outlawed any future action on fluoridation without a public vote.  

That left Bremerton as one of two cities on the Kitsap Peninsula that does not fluoridate its water. Gig Harbor is the other. Experts say children and low-income residents are harmed the most by the lack of fluoridation. 

Today, most benefits from fluoride can be achieved through proper dental hygiene and regular check-ups, said Dr. David Houpt, a dentist in Silverdale and a member of the Kitsap Dental Society. Its “greatest impact” is on “folks who cannot regularly get to the dentist or afford quality dental equipment like an Oral B or Sonicare” toothbrush. 

Almost all water contains some organic amount of fluoride, a naturally occurring mineral, although typically not enough to prevent cavities. American cities began community fluoridation in 1945 after scientists discovered that people living in areas with naturally high concentrations of fluoride had lower rates of decay. 

The practice has become a cornerstone in the United States. Fluoride is found in over 70% of public water systems. The Centers for Disease Control hailed the introduction of fluoride as one of the top public health achievements of the past century.

“Community water fluoridation adjusts the concentration of fluoride to a level that is safe and optimal for preventing tooth decay and is a proven public health prevention measure that benefits both children and adults, regardless of age, race, gender, or income,” Dr. Gib Morrow, Kitsap’s top public health official wrote in an email. “When in contact with teeth, it helps to repair early signs of tooth decay, hardens the tooth’s surface, and slows decay-causing bacteria.”

Debates over fluoride continue across the country 

Despite broad backing among public health officials and dentists, debates like the one in Bremerton over 25 years ago, persist. In recent months, dozens of American communities are reconsidering fluoride’s merits and removing it from their water, according to the Associated Press.

In a phone interview, Dr. Charlotte Lewis, a professor of pediatrics at the University of Washington who studies oral health and dental care disparities, said anti-fluoride efforts have been around for decades and come up occasionally. 

“For a long time, people have been trying to connect fluoride in the water with something bad,” she said. “Even dating back to the ‘60s, with Communist plots and conspiracy theories and things like that.”

Quarrels over fluoride resurfaced in the national media recently in part due to comments made by Robert F. Kennedy Jr. Kennedy, also a vaccine skeptic, who is President-elect Trump’s choice to lead the Department of Health and Human Services. 

Kennedy declared in November he would call for removal of fluoride from the country’s drinking water.

A controversial federal report published in August by the National Toxicology Program also appears to have added to public skepticism. The report found with “moderate confidence” that fluoride levels at rates twice the recommended limit were associated with lower IQs in children. It did not address the effects of fluoride at the recommended concentrations outlined by the CDC.

Based heavily on the report and other studies, a federal judge in California ordered in September that the Environmental Protection Agency further regulate fluoride in water over concerns about its impacts on cognitive decline.

There has been some research finding a connection between low levels of fluoride and adverse outcomes, like lower IQ or cognitive ability, Lewis said. However, many of them have “a lot of problems” and there are a number of  “better designed” studies that have found no relationship.

“The concern of the American Academy of Pediatrics and people like myself who have spent a lot of time studying these things is that we’re drawing these conclusions based on faulty studies,” she said. “We still have a lot of disparities in oral health in this country and a lot of difficulty accessing dental care for many groups. There’s research that shows if you drink fluoridated water, a lot of those disparities disappear.”

Morrow said local and state officers are aware of the national toxicology report and that Washington state Department of Health officials are examining its findings. The Kitsap Public Health District continues to support fluoridation as a “sound” health measure.

“We know that fluoridation reduces tooth decay in children and adults, helps address disparities for families with low incomes, and saves money by reducing the need for dental treatment,” he said. “People who live in communities with fluoridated water are more likely to have healthier teeth than those living in communities without fluoridated water.”

Federal government can’t dictate local water fluoridation

The federal government does not have the authority to order municipalities to remove fluoride. Those decisions fall on local water districts and city councils. That has caused some variances in neighboring communities, like on the Kitsap Peninsula.

Most unincorporated sections of the peninsula, across Pierce and Kitsap Counties, do not have fluoridated water. Annapolis and Manchester, which approved fluoridation in 1968, are the exception. The Port Gamble S’Klallam Tribe also fluoridates its water on reservation land in North Kitsap.

The Tacoma-Pierce Health Board passed a countywide fluoridation mandate in the early 2000s, requiring all public water systems to be fluoridated. But the Washington state Supreme Court struck it down in 2004, according to archives of the Tacoma News Tribune. Justices did not debate the merits of fluoride, but rather ruled the mandate was an overreach of the board’s authority. A statewide mandate in the 1970s was rejected by the state Board of Health.

Aside from Bremerton, Gig Harbor is the only other incorporated city on the Peninsula that does not fluoridate its water, according to a list maintained by the Washington DOH. 

Excluding a 1974 vote by the Gig Harbor Town Council, which unanimously opposed any state efforts to require fluoridation in local water, there appear to be few instances of debates over fluoride in Gig Harbor. 

State Rep. Michelle Caldier, R-Gig Harbor, was a teenager living in Bremerton during the 1990s when residents were debating fluoride. Caldier said she was unaware of a similar debate in Gig Harbor. No constituents have reached out to her about fluoridation issues. 

Caldier, a former dental professional, said she supports fluoridation, but only in cases where it is endorsed by the community. 

“For some communities, if they don’t have high cavity rates, it doesn’t make sense to fluoridate the water,” she said. “I’m a supporter of fluoridated water within regions that have high cavity rates as long as the community supports it.” 

Bremerton’s history with the fluoride debate

There is a broader documented history around fluoridation in Bremerton, where the topic became a hot-button issue in the late 1990s. Even before the city council voted on fluoridation in 1997, concerns about it were already brewing. 

A hearing weeks before the council’s decision drew roughly 100 people, with opponents arguing against the cost, the side effects and the choice not to drink fluoride, according to a 1999 Kitsap Sun story.  

“More and more, we find that the government thinks it knows best for us,” Rod Johnson, a one-time mayoral candidate listed as president of the anti-fluoride group Citizens for Safe Water, wrote in a letter to the Kitsap Sun a month before the vote. 

“Don’t let the government literally force this down our throats,” he said. “Water is for every body[sic]. Fluoridation is not.” 

After the city council’s vote, the citizen group of six members spent over a year gathering enough signatures for a petition. They turned in more than 2,230 signatures, and the council conceded in October 1998. Declining to adopt the petition as an ordinance, their only other option was to put the questions up for a vote. 

Bremertonians had previously gone to the polls over fluoride in 1961, about 16 years after community fluoridation was first introduced in the United States. Voters overwhelmingly rejected that proposal. The then-president of the Kitsap County Dental Society said it failed largely due to “false fears.” In contrast, the president of the Bremerton Council for Clean Water described the decision as “logical.” 

Nearly 40 years later, the result was the same. About 55% of the over 7,000 voters who turned out during a February 1999 special election rejected fluoride. The council, which had already approved buying thousands of dollars worth of fluoridation equipment, spent months discussing how the city would sell or repurpose it. 

Supporters of fluoridation spent over $15,000 during the election, more than three times as much as those in opposition, trying to quiet the backlash. In the aftermath, they argued the vote went against science. 

“I really do not know what makes antifluoridationists not be honest about the scientific studies,” Dr. Willa Fisher of the then-Bremerton Kitsap County Health District, said in 1999. “In all my experience of dealing with them they are not using science-based reasoning.”  

What the absence of fluoride shows

Disparities in oral health between communities that choose to fluoridate and those who do not is less dramatic today than it was decades ago,  said Lewis, the UW professor. Most communities had virtually no exposure to adequate levels of fluoride, prior to its introduction in community water systems. That made its presence in the following decades particularly impactful.

Communities with fluoridation still have lower cavity rates and better health outcomes, but the rise of toothpastes with fluoride and the increased number of foods made in communities with fluoridated water have helped expand access to the mineral outside of drinking water. 

Yet that does not mean community fluoridation is no longer necessary, Lewis said, comparing it to the polio vaccine. Because polio has largely been eradicated by vaccines some may question why it is still necessary, she said. That hesitancy can contribute to preventable cases. 

“It’s similar to community water fluoridation. We don’t see that many cavities or anywhere near as many cavities as we did or in the 20th century,” she said. “That’s because of community water fluoridation. If we take that away, the expectation is that we will start to see a lot more cavities.”

Conor Wilson is a Murrow News fellow, reporting for the Kitsap Sun and Gig Harbor Now, a nonprofit newsroom based in Gig Harbor, through a program managed by Washington State University.