‘Science and facts would prevail eventually’

Iowa city reinstates community water fluoridation after terminating practice earlier in year

Before water fluoridation 3 times as many cavities

Six months after community water fluoridation was terminated by the Tama City Council, the caries-preventing program was reinstated in the area in October after another council vote.

The change in heart was due in large part to a coalition of pro-fluoridation advocates who flooded the small city of nearly 3,000 in central Iowa.

“Multiple members of the dental community provided testimony in favor of fluoridation,” said Bob Russell, D.D.S., public health dental director and chief of the Iowa Department of Public Health’s Oral & Health Delivery Systems Bureau. “The department strives to protect the health of Iowans, [and] the outcome was favorable to that mission.”

Steven M. Levy, D.D.S, the Wright-Bush-Shreves Professor of Research and graduate program associate director of dental public health in the University of Iowa’s College of Public Health, was part of a contingent from the state university that delivered testimony to the council pleading for reconsideration of its decision.

“I emphasized the caries-preventive benefits and the safety of community water fluoridation,” said Dr. Levy, a member of the ADA’s National Fluoridation Advisory Committee. “Those in low-socioeconomic status households and otherwise underserved will be hurt the most. Community water fluoridation helps all ages, and it is the most cost-effective approach to caries prevention.”

Dr. Russell
Dr. Russell
The poverty rate of Tama sits at 15.5%, which is higher than the state’s rate of 11.2%. Tama is also located a few miles from the Meskwaki Settlement, a significant American Indian community. Robert Bowers, D.D.S., assistant professor at the University of Iowa College of Dentistry and Dental Clinics, was previously the dental director at the Meskwaki Health Clinic, and he testified to the council on how much the community needed fluoridation.

On top of support from allies such as the American Fluoridation Society and the ADA, Iowa brought in another advocate from a neighboring state to help them develop strategies to bring back fluoridation: Wisconsin State Dental Director Russell Dunkel, D.D.S., who has overseen many fluoridation debates in his state brought on by a phalanx of anti-fluoridation activists.

“The department was aware of similar fluoridation challenges occurring in Wisconsin that ultimately were favorable towards water fluoridation,” Dr. Russell said. “Dr. Dunkel was consulted on his approach in the public debate.”

A unified and coordinated response was crucial, said Dr. Dunkel, because of the great need of those in Tama and beyond.

“Now, with the devastating effects of COVID-19, gaps or barriers to oral health care have intensified,” Dr. Dunkel said. “With all these barriers to health care, especially for the under-resourced populations, now is definitely not the time to remove a proven safe and cost-effective method for reducing dental decay as this may be their only current access to any dental benefits.”

The city discontinued fluoridation in April in a 3-1 decision, after the area’s water superintendent showed a presentation to the council that included a video from a group of anti-fluoridation activists, Dr. Levy said.

On Oct. 4, the council voted 3-2 to reinstate the practice.

One constant voice leading the charge, Sarah Petersen, community water fluoridation coordinator for the Iowa Department of Public Health, was ecstatic at the council’s decision.

“I knew science and facts would prevail eventually,” she wrote in an email to supporters after the vote.

“It is always an uplifting moment when you are able to get fluoride reintroduced after it has been removed,” Dr. Dunkel said. “Unfortunately, as the saying goes, ‘We may have won the battle, but the war goes on.’ We still have community water fluoridation issues in Madison (Wisconsin) and a host of other cities nationally and globally. The bottom line is that we are making headway through the help from health departments from other states along with private sector stakeholders like the ADA and AFS in turning back these challenges.”

For more information on fluoride and ADA advocacy of community water fluoride, visit ADA.org/fluoride.