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Undaunted by a resounding defeat at the ballot box in 2014, opponents of fluoridation are mounting another try to convince Healdsburg voters to stop adding the substance to the city’s water supply.

Fluoride opponents are gathering voter signatures to place the issue on the November ballot, hoping the outcome will be different from last time, when 64 percent of voters said “yes” to keeping fluoride in the water and 34 percent said “no.”

This time around, they have shifted their approach to seeking a moratorium on the additive — which is widely used to combat tooth decay — until the city and fluoride suppliers provide detailed chemical reports and a written statement verifying its safety for ingestion.

Opponents also have opened up a new front in Marin County, pursuing a near-identical ballot measure to stop fluoridation in the Marin Municipal Water District, where the practice has been in place since the 1970s.

Their ultimate goal is to stop adding fluoride to the water entirely, despite scores of medical and scientific organizations that endorse the practice as a way to cut down on cavities, safely strengthen teeth and benefit families that don’t regularly visit the dentist.

But critics view the chemical compound as an unsafe form of mass medication and say it may not work in reducing tooth decay. They claim recent studies show it may cause lower IQs in children, hypothyroidism and some cancers.

“We are asking them to turn it off until they prove it is safe,” said Dawna Gallagher-Stroeh, the executive director of Clean Water Sonoma-Marin. The group is seeking to end fluoridation in Marin, as well as Healdsburg, the only community in Sonoma County that has it.

“They have to shut it off until they can provide verifiable safety studies for ingestion by all consumers,” she said.

Additives in drinking water have to meet standards for quality and safety, and fluoride conforms to those, said Alicia Malaby, spokeswoman for the California Dental Association.

She said a testing and certification program administered by NSF, formerly the National Sanitation Foundation, was established precisely so that states and waterworks facilities would have a mechanism to determine which products are safe to use.

Almost two-thirds of Californians have fluoridated water. And 75 percent of the U.S. population on public water systems — more than 210 million people — had access to fluoridated water in 2012, according to the Centers for Disease Control and Prevention.

The CDC considers fluoridation of drinking water a significant health achievement, due to the dramatic decline in tooth decay across the country.

Gallagher-Stroeh, a former Rohnert Park City Council member and fluoride skeptic, is an activist who unsuccessfully sought to convince Healdsburg voters to end the more than 60-year-old practice of adding it to the municipal water supply.

She also is opposed to a Sonoma County Water Agency proposal to fluoridate its water supply to more than 600,000 customers, including Santa Rosa, Petaluma, most other cities in Sonoma County and parts of Marin.

Getting approximately 600 signatures, or 10 percent of Healdsburg’s 6,000 registered voters to again put the issue on the ballot, is considered fairly easy, with the signature drive kicking off this week and five months to accomplish the task.

But organizers acknowledge it could be tough to get the signatures of 14,000 Marin County voters by April 30 to place the issue on the ballot there. And even if a majority of voters were to vote against fluoride, Marin water officials say there is a strong argument that their district would need to continue the practice, since state law requires utilities with more than 10,000 service connections to fluoridate if the funds are available.

Healdsburg City Council members doubt whether the outcome will be any different this time around in their city.

“It seems like voters were pretty clear. They supported what we were currently doing” with the city’s water supply, Mayor Tom Chambers said Friday.

“The community has spoken,” Councilman Gary Plass said. “From my point of view, I don’t think the science has changed that much. I think the community believes it’ s been a beneficial supplement to our water and at this point will continue to use it.”

Fluoride opponents, however, believe their cause will be bolstered by a Sonoma County Department of Health Services study that came out after the last election, indicating fluoride didn’t benefit Healdsburg children in cutting dental decay.

But Dr. Karen Milman, Sonoma County’s public health officer, said the study was not so definitive.

She said it showed Healdsburg kindergartners “have less dental decay than the rest of the community. By the time they get to third grade, the numbers are too small to show they are statistically significant.”

She expressed strong support for fluoridation.

“Studies show over and over again, after 70 years, community water fluoridation reduces dental decay by 25 percent and it’s safe and effective,” she said.

Even though a committee studying the issue recommended fluoridation of Sonoma County’s water supply, county supervisors in essence tabled the issue in May.

A majority of supervisors expressed support for fluoridation, but expressed qualms about the price tag — $4.5 million to start up the program and another $581,000 annually.

“The recommendations were that the county continue to go forward,” said Milman, who was unable to say if it will come back this year to the board for consideration.

Not only is funding an issue, but the eight cities that the county Water Agency serves could shape the decision.

Two of those cities, Sonoma and Cotati, have come out against fluoridating the county water supply. Sebastopol also came out against fluoridation, even though the city has its own water delivery system that would not be affected by the Water Agency proposal.

Gallagher-Stroeh said it could take years to get the contractors served by the water agency to agree to fluoridation, if at all.

But in the meantime, she continues to attack fluoridation as a menace, calling it a byproduct of the fertilizer industry also used in the Manhattan Project to create the atomic bomb.

Fluoride is extracted from the same phosphate rock that is later used to create fertilizers, but opponents are wrong to suggest that it comes from fertilizer, according to the Sonoma County health department website.

Although most dentists support fluoridation of water, there are contrarians, such as Micheal Lipelt, a Sebastopol dentist, naturopathic physician and acupuncturist who lives outside Healdsburg city limits.

He signed the notice to circulate the petition for the initiative against fluoridation.

“It’s considered by the FDA (Food and Drug Administration) to be a medicine. When you put it in water, it’s debatable if you can dose it appropriately,” he said, because there are so many other sources of fluoride including toothpaste, mouthwash and prepared foods.

He believes fluoride in the water contributes to low thyroid production — resulting in everything from cold hands and feet, to constipation, fatigue, hair loss and weight gain.

But fluoride defenders say those problems are a result of exposure to much higher levels of fluoride than what is found in drinking water supplies.

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