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Water fluoridation on the ballot

Dentists educate voters, tackle misinformation about the public health benefit

November 14, 2018

By Michelle Manchir

Photo of Dr. Johnson promoting water fluoridation on Election Day
Let’s talk teeth: Dr. Johnny Johnson shows enthusiasm for water fluoridation on Election Day, when Brooksville, Florida, voters said yes to retaining the public health benefit.
Voters favored water fluoridation in one U.S. city on Nov. 6, but chose to stop fluoridation in two others.

The ADA, state and local dental associations and dental professionals often play a role in helping educate municipal leaders and citizens about the safety and efficacy of water fluoridation, which has been found safe and effective in preventing tooth decay by at least 25 percent in children and adults.

The ADA can assist fluoridation advocates in communities discussing water fluoridation. For more information or resources, visit or contact Jane McGinley, manager of fluoridation and preventive health activities for the ADA Council on Advocacy for Access and Prevention.

Florida city chooses fluoridation

Voters in Brooksville, Florida, a city of about 8,100 north of Tampa, overwhelmingly voted to retain water fluoridation, with about 65 percent, or 1,900, voters saying yes to the public health benefit.

The city began adding fluoride to its water supply in the 1980s, but stopped at some point until about 2013, according to an article in the Tampa Bay Times.

Drs. Jose Peralta, Doug Roth and Robert Heydrich were among the local dentists who helped spread the word about fluoridation's safety and efficacy, said Dr. Johnny Johnson, a pediatric dentist from a nearby county in Florida and president of the American Fluoridation Society, a fluoridation advocacy group. Dr. Johnson said he worked on behalf of the Florida Dental Association and with the local health department on an education campaign to ensure Brooksville voters weren't swayed by misinformation online and from outspoken advocates opposing fluoridation.

Efforts included interviews with local media and speaking at city council meetings, sharing the slogan "Protect Your Teeth: Vote Yes to Keep Brooksville Fluoridated." The American Fluoridation Society made and distributed T-shirts and Dr. Johnson talked with voters outside of a polling place on Election Day while wearing a tooth costume.

Image of fluoridation stock artDr. Johnson said he emphasizes the cost effectiveness and safety of fluoride when talking with the public. It costs Brooksville less than 50 cents per person per year to fluoridate the water, he said.

Ultimately, Dr. Johnson credits the public health win to residents' familiarity with fluoridation's advantages.

"They've had it for almost three decades. They were behind it," Dr. Johnson said, adding that there was a "wonderful group effort" to help educate voters.

"Physicians and dentists can contribute so much to the public discussion," he said. "Even if you're just one person, you can help get the word out."

'Uphill battle' in rural Missouri

Dr. Joe Richardson has spent most of his dental career in his hometown of Houston, Missouri, a city of about 2,000 about 160 miles southwest of St. Louis. He remembers what some children's teeth were like before water fluoridation began there in 2002, and he worries he'll see that same high level of caries down the road, since voters chose to end fluoridation Nov. 6.

"We had rampant caries," he said. "We don't see that anymore."

Dr. Richardson said an organized group that opposed fluoridation held workshops before Election Day in Houston, disseminating faulty science and perpetuating myths about fluoride.

"Once they spread doubt about the safety of it – that misinformation is so hard to overcome," said Dr. Richardson, who worked with the Missouri Dental Association, the Missouri Coalition for Oral Health, the American Fluoridation Society and the ADA on an educational campaign, Keep Houston Smiling, that involved mailers, letters to the editor and talking with community members whenever possible.

Dr. Richardson and other public health advocates also faced difficulties with the local city council, he said, adding that others facing fluoridation discussions in their communities should consider developing strong relationships with the local leaders.

"It is key for health professionals to have regular contact with city leadership from the get go," he said.

The vote came in at 482-292 in opposition to fluoridation, according to the local newspaper, the Houston Herald.

"We learned a lot and I hope it will help out down the road," said Dr. Richardson. "You have to learn and move forward and try to keep it from happening somewhere else."

Ohio city to remain unfluoridated

The largest of 22 Ohio cities that doesn't have fluoridated water, Springfield, Ohio, will stay that way after voters rejected it on Nov. 6, according to the local newspaper, the Springfield News-Sun. About 53.7 percent, or 8,228, said no to fluoridation for this city about 50,000 about 25 miles Northeast of Dayton.

While the Ohio legislature mandated water fluoridation in 1969, 30 communities, including Springfield, took advantage of an "opt out" clause, according to the Ohio Department of Health. Since that time a number of those communities have reversed their earlier decision and are now fluoridated. Springfield made several prior attempts to adopt fluoridation, but the measure failed.

In other news

Two other municipalities earlier this year affirmed fluoridation. City officials in Woodbine, Iowa voted unanimously to contribute the optimum level fluoride to its water supplies for the city of about 1,500.

Meanwhile, a community health center in Hayward, Wisconsin, will help the city of about 2,000 maintain fluoridated water. The city council in September voted 4-1 to accept $10,000 per year on an ongoing basis from NorthLakes Community Clinic to continue adding fluoride to the city's water system, according to meeting minutes on the city's website