“They didn’t seem to have any sway with the residents,” said Lisa Martelly, the head of the Swansea Water District’s Board of Commissioners, who said that regardless of decades of scientific research extolling the health benefits of fluoride, Swansea voters “just weren’t going to believe it.”
The debates and outcomes in Somerset and Swansea are a preview of what may become a common fight throughout the country if Kennedy is confirmed as secretary of Health and Human Services. A vocal critic of fluoridation, Kennedy recently said, “The Trump White House will advise all US water systems to remove fluoride from public water.” Trump has supported the statement.
The Fluoride Action Network, a national opponent of fluoridation, identified five places in the United States last year where voters rejected fluoridation, and another 10 in 2023.
A naturally occurring mineral, fluoride was first added to public water 80 years ago this month in Grand Rapids, Mich. Fluoridation helps fight cavities in part by building enamel in children’s growing teeth and restoring it in adults, and experts say its dental benefits have long been documented.
But segments of American society have always opposed it. As far back as 1964, the movie “Dr. Strangelove” parodied opponents with the character of a mad general convinced fluoridation was a communist plot.
Massachusetts, despite its progressive reputation on public health matters, is more lukewarm about water fluoridation than the rest of the country. Nearly three-quarters of the country receives fluoridated water, but in Massachusetts, about 58 percent of the population does, according to 2022 data from the Centers for Disease Control and Prevention. Nationwide, Massachusetts ranks 36th for the percentage of state residents who have access to fluoridated water.
All of Cape Cod and Western Massachusetts, and much of the central part of the state, do not fluoridate public drinking water supplies. About 500,000 people in Massachusetts get their water from private wells, which can have naturally occurring fluoride in them.
Local government agencies set fluoridation policies in most of the country, including Massachusetts, and the state’s lower rate of fluoridated public water is in large part due to Worcester and Springfield, the state’s second- and third-largest cities. For decades, residents of both cities have consistently voted against efforts to introduce fluoridation. A 2022 study found children from Springfield enrolled in MassHealth had 44 percent more claims for dental procedures than those in Lowell, which does fluoridate.
“We know it works. We see it,” said Myron Allukian Jr., former dental director for the Boston Public Health Commission and a faculty member at both Boston University and Harvard’s dental medicine schools. “We don’t have to measure it.”
One hundred twenty Massachusetts municipalities are fully fluoridated, and 10 others receive some fluoridated water, according to state Health and Human Services data.
Kennedy has claimed that public water fluoridation contributes to conditions including arthritis, bone cancer, thyroid disease, and low IQ, though there is no evidence the levels of the mineral currently recommended in fluoridated water, 0.7 milligrams-per-liter, according to the US Public Health Service, cause any of these conditions. His statements came in the wake of a federal judge’s order in September directing the US Environmental Protection Agency to further regulate fluoride after concluding water fluoridation could pose a risk to the intellectual development of children.
The EPA has set a maximum level of fluoride in public drinking water at 4.0 mg/L, and recommends no more than 2.0 mg/L, well above the recommended fluoridation amounts. But recent reviews, including an article published this month in the Journal of the American Medical Association, have raised questions about fluoride’s safety. The most recent analysis reviewed 74 studies and found signs that fluoride levels lower than 2.0 mg/L were associated with small decreases in children’s IQ. The study noted that hundreds of thousands of Americans use well water with fluoride levels that exceed 2.0 mg/L. The analysis did not find clear signs that drinking water with fewer than 1.5 milligrams-per-liter of fluoride in it affected IQs.
Numerous experts have called that report misleading, however, saying it included many biased studies and questionable methodologies, such as relying on point-in-time measures of fluoride in urine, and did not review a single study from the United States.
“The concern I have is this is now becoming much more of a political issue than one based on science and health,” said Catherine Hayes, chair of the Department of Oral Health Policy and Epidemiology at the Harvard School of Dental Medicine.
Toothpaste with added fluoride doesn’t provide the same benefits as fluoridation for young children, whose developing teeth are fortified by fluoride in water before they erupt. Experts say fluoridation is particularly valuable in poorer communities that may struggle with access to dental care or other sources of fluoride.
“It’s leveling the playing field for people who may not have access to professional treatments,” said Kathy Lituri, another faculty member at BU’s dental school.
The distrust of authority in Swansea in part stems from a larger, long-running problem with the town’s drinking water that goes back decades, said Martelly, with the Swansea Water District. The town suffers from a water shortage, she said, and more than a decade ago, opened a $20 million desalination plant using water from the nearby Palmer River. Instead, the plant was a bust: the source water was at times saltier than the plant was designed to handle.
The town’s water also became brown and smelly from iron and manganese, which itself can cause some neurological harm if ingested at high levels over a long period, that were dislodged from old pipes. The community was fed up, Martelly said. Then, during the pandemic, Swansea temporarily stopped fluoridating due to a shortage of the mineral, which led the water district to seek a vote among town residents in May 2023 about whether to resume the process.
Martelly herself was on the fence about fluoridation.
“The anti-fluoride argument was somewhat compelling to me because we already have so much crap in our water,” she said.
While Swansea residents Chris Minior and his wife, Donna Arruda, did not vote on the question in 2023, they are strong opponents of fluoridation.
“It’s a neurotoxin that’s a waste product,” said Minior, an echo of Kennedy’s talking points.
The couple has also had brown water come out of their taps and agreed the desalination plant’s failure contributed to their distrust of experts.
“The whole desalination plant was probably a big scam,” Minior said.
But, Joyce Moore, a Swansea resident and former dental hygienist who now consults on infection prevention, was deeply frustrated by the decision. She noted how few Swansea residents bothered to even vote, about 60. She spoke in favor of fluoridation, but didn’t think it would be necessary to marshal data and other scientific evidence to bolster the point.
“I was so gobsmacked we were even having a discussion about it,” she said.
As in Swansea, voters in neighboring Somerset expressed passionate opinions on fluoridation.
“Take it out of the water tomorrow,” one resident said during a November public meeting, according to coverage in the Herald News. “Because otherwise you’re just murderers.”
At a special Town Meeting, though, 53 votes supporting fluoridation overcame 20 votes opposed.
Ironically, the Somerset vote could have repercussions in Swansea, which plans to address its water shortage by paying to tap Somerset’s fluoridated supply, Martelly said.
In a statement last week, Robert Lima, the clerk of the Somerset Board of Water and Sewer Commissioners, said another special meeting is scheduled for February and a petition to end fluoridation is expected to again be on the agenda.
Jason Laughlin can be reached at [email protected]. Follow him @jasmlaughlin.
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