Clark County ranks among the worst in Ohio for children’s dental health, but the Springfield community remains divided over whether it should fluoridate its drinking water to address it.
Clark County health leaders and local dentists believe adding fluoride to the public water supply will reduce dental decay but a vocal group of residents believe it will be harmful to the community.
About 67 percent of children in Clark County have a history of tooth decay and about 40 percent have untreated cavities, according to a recent study of third-grade students in Ohio completed by the Ohio Department of Health. Those numbers rank Clark County among the worst in the state, the study says.
The Clark County Combined Health District is seeking approval from city commissioners to allow residents to vote on fluoridating the public water supply in Springfield this year, which Clark County Health Commissioner Charles Patterson said will improve dental health for more than 85,000 residents.
Springfield city commissioners rejected placing the issue on the ballot in May to provide more time to educate the public, but they will likely reconsider it for the November ballot. The deadline to file a ballot initiative for the November election is Aug. 8, according to the Clark County Board of Elections.
Patterson hopes to have commissioners approve going on the ballot as soon as possible to provide time for both sides to educate the community about the issue, he said. It could be discussed by city commissioners next month, he said.
“Some communities in Ohio have been fluoridating water for over 50 years,” Patterson said. “It’s safe and it’s the most effective way to prevent oral health decay.”
Springfield resident Debbie Catrow fought against the issue when it was last on the ballot in 2005 and plans to continue the battle this year, she said. Other Ohio cities with fluoridated water have similar children’s oral health problems, Catrow said.
“It’s not a magic wand,” she said. “Poor dental health is a result of not having enough dentists. Few dentists will take Medicaid patients. That’s where the crisis lies.”
The Mad River Dental Society supports placing fluoride in the water, said President Dr. Bill Lord, a Springfield dentist.
In his experience, children’s tooth decay is a big issue in Springfield, especially considering the demographics of certain neighborhoods, he said.
The overall benefit of fluoride in water to prevent cavities has been proven in studies time and time again, he said.
“I can only imagine that putting fluoride in the water would be very helpful for that,” Lord said.
In 1969, Ohio legislators passed a law requiring fluoridation of public water supplies that serve more than 5,000 people. However Springfield voters approved being exempt from the law later that year. The city was one of the 30 who approved becoming exempt, according to the Ohio Department of Health.
Since that time, nine cities, including Bellefontaine, Tipp City and Fairborn, voted to add fluoride to public water systems. Springfield is the largest of 21 Ohio cities without fluoridated water, according to ODH.
About 85 percent of Ohio residents have access to fluoridated water, Patterson said.
Fluoridation was placed on the ballot in Springfield in 2005 and was defeated as 57 percent of voters came out against the issue. Throughout the city, just five of 39 total precincts voted in favor of the issue. Many of those opposed expressed concern about adding a potentially toxic chemical to Springfield’s water.
Other communities in the region also have voted against placing fluoride in drinking water. Yellow Springs rejected a fluoride measure in 2011, while Xenia has rejected adding fluoride twice since 2005, according to the Fluoride Action Network, a national group that opposes fluoridated water.
In 2015, the No. 1 complaint among patients at the Springfield Regional Medical Center emergency room was oral health pain, Patterson said. One of the best evidence-based practices to reduce that issue is to consider fluoridating the water supply, he said.
More than 32 percent of Clark County residents have had between one and five permanent teeth removed because of tooth decay or gum disease, according to the most recent Community Health Assessment completed in 2016. Later that year, oral health was identified as one of the main areas to improve locally as part of the Community Health Improvement Plan.
As part of the fluoridation process, Springfield would have to pay for improvements to its water plant. Wilmington is currently building an addition to place fluoride in its water after voters approved it at the polls in 2016, according to the Ohio Department of Health. The entire plan costs about $325,000, including equipment, some of which will be returned through the ODH’s Fluoride Assistance Program.
Any costs to the city of Springfield would likely come from its water fund and not its general fund, Patterson said.
“Research shows that any dollar invested in fluoridation is recouped in additional dollars in prevention,” he said. “It’s a good investment for the public.”
Cost analysis studies show its cheaper for communities to fluoridate water than it is to provide dental care, Patterson said.
Several communities in Clark County, including Northridge, Medway and Park Layne, add fluoride to their water supply, which affects about 16,000 people, Clark County Utilities Director Chuck Bauer said. The cost for fluoride is about 13 cents per month per account in those areas, Bauer said. The county also pays maintenance and capital costs for any infrastructure, he said.
“Prevention is much cheaper … The peer-reviewed, factual studies are clearly in favor of community water fluoridation as the most cost-effective ways to prevent oral health decay,” Patterson said. “It’s just a fact.”
‘Protect our water’
Catrow, however, believes a community without fluoridated water “is not just a good thing, it’s a phenomenal thing,” she said.
“We don’t have this toxic waste in our water, what a great asset to our community,” Catrow said. “I don’t think it’s a solution to the dental crisis.”
Some studies show damaging effects of fluoridating water, she said, including reduced IQ in children. The community should focus on providing better access to dental care, Catrow said. Children and young mothers also should receive more education about the ways nutrition and sugar affect teeth, she said.
“The money would be better spent teaching children to brush their teeth properly,” Catrow said.
Excess fluoride is also ruining local streams in other cities, she said.
“We have to protect our water,” Catrow said.
The anti-fluoride campaign will do its best to educate the community about fluoridated water, she said. She plans to purchase an expensive filtration system regardless of its passage, but said others may not be able to afford it.
“The people of Springfield have twice already (voted against it),” Catrow said. “They’re going to keep doing it until they finally beat us.”
When he first came to Ohio more than 30 years ago, Dr. Paul S. Casamassimo — now a professor emeritus at the Ohio State University College of Dentistry — was told two metropolitan areas, Springfield and Mansfield, didn’t have fluoridated water.
Over the years, he’s examined children with extensive tooth decay from those communities.
“In many cases, they need to have their teeth removed,” Casamassimo said. “They’re beyond fixing.”
Fluoride is the best preventive technique that’s been discovered to prevent tooth decay, he said. It’s also an inexpensive method that protects people despite their lack of oral health knowledge, a big issue in both inner city and rural communities, Casamassimo said.
“It’s literally the best deal in dental insurance that anyone could possibly get, in terms of minimizing the cost to the community and the patient,” he said.
Fluoride is also safe to add to drinking water, he said, despite some studies that have linked it to cancer, brittle bones and autism.
“None of those have been proven to be true using rigorous scientific methods to test their validity,” Casamassimo said. “It’s really safe.”
People in communities without fluoridated water are getting it whether they want to or not in small amounts through food and beverages coming from other communities with fluoridated water, he said.
“You can’t run and hide from it,” Casamassimo said. “We have so many fluoridated communities in Ohio and throughout the country with fluoridated water that invariably anything you eat has some fluoride in it.”
The water in Springfield is not as healthful as it could be without fluoride, he said.
“If this can be changed, it means better health for your community, less expense paying for dental and less demands on us as dentists,” Casamassimo said. “We don’t enjoy having to pull teeth or fix teeth on 3, 4and 5-year-old kids. That’s the worst thing that can happen to us on a Monday morning.”
With adequate fluoride, there’s a certain amount of protection on teeth against sugar that may cause tooth decay, Casamassimo said. While tooth decay is still an issue in Cleveland and Columbus, he said it’s nowhere near the issue it is in other communities without fluoridated water, such as Springfield.
“It will change the lives of many, many children,” Casamassimo said.
Too much fluoride
Earlier this month, the Fluoride Action Network sent an e-mail to both Springfield and Clark County commissioners with multiple reasons about why it should oppose placing fluoride in Springfield’s public water system.
Despite more than 70 years of fluoridated water in some areas and more than 60 years of using fluoride toothpaste, U.S. Sen. Bernie Sanders proposed a bill to increase dental care throughout the United States in 2015, the e-mail said.
People are being overexposed to fluoride, said Dr. Bill Osmunson, a Bellevue, Wash.-based dentist who serves as director of the Fluoride Action Network. About 60 percent of adolescents are showing fluoride overdose symptoms, such as discolored teeth, he said.
“It’s not time to add more,” Osmunson said. “We need to be cutting back on the amount of fluoride. We need to find out why children are getting so much fluoride.”
About 10 percent of people are drinking too much fluoridated water, he said. He’s also concerned that infants who are fed formula with fluoridated water are getting more than 200 times the recommended dosage.
“We’re giving way too much to infants during the development of their brain, their thyroid and their bones,” he said.
Osmunson promoted fluoride for about 25 years after dental school, but he said research shows fluoride doesn’t do any good — it’s actually harmful if you get too much.
Fluoride also isn’t recommended to be swallowed by the Food and Drug Administration, Osmunson said.
“It seems borderline criminal to be forcing everybody to ingest something the Food and Drug Administration says ‘Do not swallow,” Osmunson said.
Too much fluoride can cause white spots on your teeth, Lord said, but it’s not enough to kill you or cause cancer. Anything taken in large amounts can be dangerous, but overfluoridation is a gray area, he said.
“On a large, large, large scale, fluoride can be (harmful),” he said. “But if a kid eats a whole tube of toothpaste, it’s not going to kill them. Does it make them sick for awhile? Sure. We’re not going to take fluoride out of toothpaste because a kid eats a whole tube because it tastes so good.”
The Springfield News-Sun provides complete coverage of important public health issues in Clark and Champaign counties, including recent stories about prescription pain medication procedures in Ohio and an uptick in influenza cases this year.
By the numbers
32: Percentage of Clark County residents who have had between one and five permanent teeth removed because of tooth decay or gum disease.
38.1: Percentage of Clark County adults who don’t have health insurance.
14.5: Percentage of Clark County children who have never been to the dentist.
Source: 2015 Clark County Community Health Assessment