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More than 60 years after Healdsburg voters approved adding fluoride to the city’s water to fight tooth decay, they are being asked in Tuesday’s election to once again either approve or reject the practice, foreshadowing a bigger battle that could come at the county level over fluoridation.

Generations of Healdsburg residents have been drinking fluoridated water since 1952, when the city became one of the first in the state to add it, part of a practice that now includes a majority of California communities and about 75 percent of the public water systems in the United States.

Although Healdsburg is the only city in Sonoma County that adds fluoride to its water, the county Department of Health Services is also evaluating potential fluoridation of the county Water Agency’s supply. The agency serves more than 600,000 customers in the North Bay, including Santa Rosa, Rohnert Park, Cotati, Petaluma, Windsor, Sonoma, Valley of the Moon and parts of Marin.

Dental and health organizations support fluoridation as a time-proven, cost-effective way to cut down on cavities, to safely strengthen teeth and also benefit families who don’t see a dentist regularly.

“The oral health of a generation of kids is at stake,” Healdsburg Mayor Jim Wood said about Tuesday’s vote. Wood is a dentist and supports fluoridation.

A passionate group of fluoride opponents earlier this year gathered more than enough signatures to place the referendum on Tuesday’s ballot. They have canvassed every neighborhood in Healdsburg spreading a message that fluoride is a dangerous toxin, a contention that health experts say is unfounded with the doses delivered in U.S. drinking water.

“We are assaulted by so many environmental toxins in our air and different pollutions. To put a toxic substance in our water is not reasonable,” said Julie Kennedy, an employee at a Healdsburg lumber and building materials company who has been knocking on doors with a core group of about a half-dozen people trying to convince voters to end fluoridation.

Dentists and other health professionals are pushing back, saying fluoridation opponents are misguided and ignore overwhelming scientific data that fluoride added in minuscule amounts to the water — such as less than one part per million in Healdsburg — is essentially safe.

The question posed by Healdsburg’s Measure P on Tuesday’s ballot is a simple one: “Shall the City of Healdsburg continue to fluoridate its water?”

But voters have had to try to sort through competing claims made by each side, both citing scientific studies to bolster their arguments.

Is fluoride added to water a form of mass medication that can lower IQ, decrease thyroid production and cause unsightly teeth discoloration, as fluoridation opponents argue in their ballot initiative? Or are anti-fluoridationists ignoring sound, validated science and endorsements by a long list of health organizations including the Centers for Disease Control and Prevention, the U.S. Surgeon General, World Health Organization and National Cancer Institute?

Those who answer “yes” to fluoride in Healdsburg and vote to continue to the ongoing practice are backed by the California Dental Association. The group last month contributed $45,000 in cash to the “Save Our Smiles” campaign and has helped pay for several voter mailers supporting continued fluoridation.

With non-cash contributions — basically staff time contributed by the state Dental Association — the “Yes” campaign reported more than $56,000 in contributions as of Sept. 30.

In contrast, the “No on Measure P” committee reported $11,400 in contributions, with less than $3,000 of that coming in cash.

Wood and other supporters of fluoridation said the arguments against the practice have always been fear-based, like in the 1950s when it was decried as a communist plot that would lead to mind control.

“As science evolved, the arguments have changed. The passion of people who don’t want fluoride remains,” he said. “I just believe in my heart, and the stacks of scientific research I have, that fluoridation is the right thing to do.”

But Dawna Gallagher-Stroeh, a nutritionist and former Rohnert Park councilwoman who is fighting fluoridation in Healdsburg, as well as the proposal to add fluoride to the county supply, says it amounts to “drugging a population.”

Gallagher-Stroeh insisted that in walking door-to-door in Healdsburg, she and fellow canvassers could see evidence of fluorosis — a type of mottling or streaking of the teeth — among some residents.

“You can’t have a Miss America coming from Healdsburg if they grew up there, unless they have a hundred grand to fix their teeth,” she said.

The condition is most prevalent and severe in populations that consume drinking water with elevated levels of naturally occurring fluoride, including parts of the developing world.

Fluoride proponents said if there were serious problems associated with fluoridation in Healdsburg it would be truly apparent.

“People in Healdsburg are just as happy and healthy as anywhere else, except they have fluoride in the water,” said Mayor Wood. “Maybe there is a small pool of people out there that have a sensitivity to fluoride. Anything more than a small population would be manifested in many ways in the community.”

“As a dentist in Healdsburg, I see firsthand the benefits of having fluoridation here,” said Shawn Widick, who has practiced in Healdsburg for 16 years.

He said he and his colleagues see the worst rates of decay in non-Healdsburg children in programs that provide dental care to kids who come from other parts of the county.

Fluoride proponents note that it strengthens teeth and makes them more resistant to acid attacks and decay from bacteria formed when sugar breaks down in the mouth.

According to the county Department of Health Services, every day 10 to 12 children in Sonoma County have to go under general anesthesia — with all its risks — to treat severe dental disease.

Widick said 25 dentists who either practice or live in Healdsburg support the continuing fluoridation of the city’s water.

But there are dentists who buck the trend, like Michael Lipelt, who practices dentistry in Sebastopol and is also a naturopathic doctor and acupuncturist.

He contends the most obvious problem is an inability to accurately dose fluoride because of the many sources that it comes in, from toothpaste to mouthwash, and in food prepared in places where water is fluoridated.

In the 1930s through the 1950s, he said fluoride was used to reduce the function of an overactive thyroid and he believes it’s having the same result now on people.

“I see an outstanding number of underactive thyroids — people with low iodine content in their bodies,” he said.

Howard Pollick, a clinical professor at UC San Francisco’s school of dentistry, said alarms about the effects on the thyroid “are just another example of a red herring thrown out to distract people.”

He said a 2006 report by the National Research Council of the National Academy of Sciences concluded fluoride had no endocrine effects at 4 parts per million, about five times what is found in Healdsburg water.

“There really isn’t any concern about thyroid effects from fluoridation,” he said.

Fluoride critics note that toothpaste tubes warn against swallowing too much toothpaste and, if so, to seek medical attention to avoid fluoride overdose.

But Santa Rosa dentist Anthony Fernandez, a member of the Redwood Empire Dental Association who is a vocal proponent of fluoridation, said toothpaste has 1,000 times more concentrated fluoride than what is in drinking water.

Pollick, who also serves as chairman of the fluoridation advisory committee for the state Dental Association, acknowledged that the national standard for safe level of fluoridation in water supplies is likely to be revised from the current 0.8 parts per million, to 0.7 per million, to reduce the risk of consuming too much fluoride from multiple sources.

Opponents also have raised concerns about the impact of fluoridated water on fish and wildlife.

That is one of the issues being studied by the county Department of Health Services as it weighs the possibility of fluoridating the county’s water supply. Any decision will ultimately be made by the Board of Supervisors.

Consultants this month released a draft report indicating fluoridation is unlikely to harm endangered and threatened fish such as coho and chinook salmon in waterways leading to the Russian River.

Some cities in Sonoma County have rejected the idea of fluoridation. The city councils of Cotati and Sebastopol have opposed fluoridation of the county’s drinking water, even though Sebastopol has its own water supply that would not be affected directly by the county Water Agency proposal.

Pollick said opponents make claims that are not true, including in the Healdsburg ballot initiative, such as supposed warnings from the American Dental Association that babies younger than 6 months old should not ingest any fluoride.

He said the ADA never made any such statement, and that fluoridated water can be used for reconstituting infant formula when breast feeding is not possible.

He also disputes the “No on Measure P” claim that a large government study in the late 1980s found no benefits from fluoridation.

Pollick said the study found 18 percent less tooth decay in permanent teeth among children with lifelong exposure to fluoridated water and an even better result when children with exposure to supplemental or topical fluoride were excluded. He said the ballot argument refers to a highly criticized analysis conducted by a leading fluoride opponent not connected with the study.

Pollick said oftentimes people will latch onto a study that shows fluoride is hazardous without taking into account the high dosage or concentration that can cause problems.

Such was the case with the claims that fluoride can lower IQ, he said, which involved a study of populations in China and Iran exposed to naturally occurring forms of fluoride, including from burning peat.

“You can have too much of a good thing,” he said, adding that what distinguishes a poison from a remedy is the dose.

“Fluoride deniers are adamant that any level is harmful,” he said. “They’re not willing to accept there is so much evidence that supports the efficacy and safety of water fluoridation.”

You can reach Staff Writer Clark Mason at 521-5214 or clark.mason@pressdemocrat.com.

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