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The Sonoma County Board of Supervisors on Tuesday pressed forward with a controversial plan to put fluoride into most of the county's drinking water during an emotional hearing in which dozens of speakers debated whether the chemical compound is a panacea or a poison.

Dentists and other health care professionals, along with a larger, more vocal contingent of fluoride skeptics, packed board chambers for the marathon five-hour public hearing.

Despite reservations expressed by some supervisors, the board unanimously authorized additional financial analysis and engineering studies of adding fluoride to most of the county's drinking water. The final decision is not expected until March 2014.

"We can't ignore the data and the statistics in this county when it comes to the oral health epidemic," Supervisor Efren Carrillo said.

Dozens of speakers, however, expressed anger and dismay over the proposal, citing health concerns, distrust of mainstream science and doubts about how the county would be able to fund the project.

Based on preliminary estimates, the project could cost up to $8.5 million in capital upgrades to the county's central water system, plus ongoing upkeep starting at $973,000 a year, according to a county report.

"I'm assuming this will be necessary because our roads will be so bad we won't be able to drive to the dentist," said Elizabeth Van Dyke of Guerneville, in what became a recurring theme about the county's spending priorities.

Fluoride is a chemical compound and was introduced to U.S. drinking water nearly 70 years ago. About three-quarters of the nation's population served by public water systems, or about 196 million people, are now receiving fluoridated water.

The measure is backed by the Centers for Disease Control and Prevention, the surgeon general, the World Health Organization and the American Dental Association, which called it "the single most effective public health measure to prevent dental decay."

Currently in Sonoma County, the only fluoridated water is delivered to residents of Healdsburg, the adjacent Fitch Mountain area and Two Rock Coast Guard Base.

Dr. Lynn Silver Chalfin, the county's health officer, told the board that in Sonoma County every day, 10 to 12 children undergo general anesthesia while being treated for severe dental disease.

She cited a CDC study that found that for every dollar spent on community water fluoridation, the result is a $38 savings on dental expenses.

Stacey Stirling, dental operations manager for St. Joseph Health Sonoma County, described a 5-year-old girl whose face was so swollen because of oral disease her eyes were nearly shut.

Stirling said the girl's parents brought her to the emergency room and that she spent five days in the hospital. The total bill for her dental care: $80,000.

"We see children like this every day," Stirling said. "My fear is that we're going to see a death in Sonoma County, for those children who don't make it in in time."

Santa Rosa dentist Anthony Fernandez, a proponent of fluoride as a preventive measure, said the least expensive filling he offers is $160. He urged supervisors to "do the right thing," and for dramatic effect, he played the shrill sound of a dentist's drill on the public address system via his smartphone.

Opponents were not amused. Several speakers likened fluoride to a toxic substance they said can cause a range of health ailments when ingested, everything from bone cancer to hip fractures.

"You're listening to members of the dental association that gave us mercury," Dr. Robert Rowen, who has an integrative and nutritional family medicine practice in Santa Rosa, told the board.

He said if he were to prescribe medications the way he said supervisors are essentially considering with mass fluoridation, the medical establishment would "jerk my ticket," meaning strip him of his licence to practice.

Several speakers said county health officials should concentrate their efforts instead on getting children weaned off of sugar and soda drinks.

They also raised the issue of people taking personal responsibility to teach their children good oral-hygiene habits.

The dissenters clearly got to Supervisor Shirlee Zane, who said after more than two hours of public testimony, "We are so behind the curve here. Shame on us for being so far behind."

She then pointed her finger toward the audience and said, "I have listened to you. You will now listen to me."

That prompted Brenda Adelman, a Guerneville resident and longtime activist on Russian River water issues, to stand up and yell loudly back at Zane, "Please don't point your finger at me. That's clearly obnoxious."

Supervisor David Rabbitt, the chairman of the board, pounded the gavel several times seeking order.

"I'm not going on until they stop," Zane said.

The fluoridation project would affect three quarters of the county, including 350,000 residents served by the Sonoma County Water Agency in Windsor, Santa Rosa, Rohnert Park, Cotati, Petaluma, Sonoma, Forestville and the Valley of the Moon. More than 50,000 Novato-area residents served by the Water Agency also would get fluoridated water for the first time.

Perhaps the biggest hurdle to the county's plans is that it would require the unanimous consent of all eight of the water agency's retailers.

Rabbitt cautioned that the last time those agreements were opened up for review it took "eight-and-a-half years to bottle it up again."

The Graton Community Services District is not one of the major municipal systems that receives water from the water agency. But Robert Rawson, the district's general manager, said the district opposes the fluoride project because he said the chemical will cause environmental damage, including to aquatic organisms.

Rabbitt and Supervisor Susan Gorin expressed concerns about how the project would be funded and, also, over how much money the county is spending on studies. The engineering analysis approved Tuesday is estimated to cost the county about $103,000.

At questioning from Gorin, County Counsel Bruce Goldstein said the cost of the flouride project could be passed on to ratepayers.

Gorin said she also was "conflicted" about putting fluoride in water, saying she's not expecting it to lead to "miraculous cures, especially among our disadvantaged population."

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