Residents of the Boothbay region will decide next month if they want to continue fluoridating public drinking water, a debate that surfaces occasionally in Maine and across the country that pits concerns about personal choice against public health benefits.

The vote in the Boothbay Region Water District – Boothbay, Boothbay Harbor and Southport – comes 18 years after residents added fluoride to their drinking water. November’s repeal effort is led by a group that questions its safety and efficacy.

“Fluoridating the public water supply takes away all of the ability for an individual to choose if and when they want to ingest fluoride,” said Anna Christina Rogers of Boothbay Harbor, who leads the Fluoride Opposition Committee which put the referendum question on the ballot.

But the U.S. medical community widely agrees it’s a good public health strategy, one that is safe, cost-effective and especially important for the most vulnerable members of the community, including low-income children whose families have limited access to dental care.

Fluoride is commonly added to public water supplies across the country and has long been recognized by the U.S. Centers for Disease Control and Prevention as one of the 10 great public health achievements of the 20th century. The practice began in Michigan in the 1940s as a way to prevent tooth decay and is now mandated in 15 states, Washington, D.C., and Puerto Rico.

Water is fluoridated in more than 125 Maine towns, according to the Maine CDC, which says the practice is safe, inexpensive and effective. Because many people use private wells, about 40% of Maine’s total population has fluoridated drinking water.

Health experts say it prevents tooth decay, especially in children. But the practice routinely faces pushback from people who argue that it leads to mass medication and over-fluoridation.

Many Maine communities began adding fluoride as early as the 1960s. Another 10 began the practice in the early 2000s, including in the Boothbay Region and the Kennebunk, Kennebunkport and Wells Water District – which voted in 2016 to reverse a 2002 referendum and stop adding fluoride to its drinking water.

The sodium fluoride used by the Boothbay Region Water District is imported from China because there are no North American sources, according to the water district. But that has been suspended since early September because of supply chain issues.

Dr. Steve Mills, a semi-retired pediatric dentist who sits on the board of the Children’s Oral Health Network of Maine, advocates for water fluoridation and said a vote to stop it in the Boothbay region is a “step backward.”

“Dental decay is still a problem. It’s not trivial and it effects those who can least access care,” he said.

A REFERENDUM ON FLUORIDE

Rogers, an herbalist and massage therapist, said she has heard people in the area talking about ending water fluoridation, but momentum toward making that change didn’t start building until earlier this year when the Fluoride Opposition Committee brought the issue to the three towns served by the water district. Boothbay and Southport agreed to put a referendum question on the November ballot.

The Boothbay Harbor Board of Selectmen did not vote on the proposal, but it will be on their ballot because state law says if two of the three towns served by the water district call for a public vote, the third town has to do the same, said board member Denise Griffin.

Griffin said most select board members appear to favor continuing the practice because of the benefits to children and seniors.

“All the dental health professionals and scientists in the area have said it is good and appropriate for the community,” she said.

Rogers, who speaks on behalf of the Fluoride Opposition Committee and filters fluoride out of her own water, said water fluoridation is “a very outdated practice” and that many of the children in the region don’t benefit from it because their homes use well water. Fluoride is most effective when applied topically, she said.

“We need to teach our kids to brush their teeth, to take care of themselves and not just supplement the public water supply because that’s the easiest way to go,” Rogers said.

Stevie Hale of Boothbay Harbor, who spoke at a public hearing on the referendum, said she questions whether water fluoridation is right for the community because of the number of people on well water and the region’s older population. She raised concerns about the impact of fluoride on bone density and whether infants who drink formula and others who consume large amounts of water could overdose on fluoride.

The Environmental Protection Agency regulates and sets standards for how much fluoride is allowed in public water systems to prevent people from drinking too much.

Mills, the pediatric dentist, presented scientific evidence at that hearing saying studies show water fluoridation is not connected to cancer, decreased bone density, or neurological issues. He said he has not seen evidence of patients drinking too much fluoride and developing fluorosis, a condition that causes pain or tenderness and can change the appearance of tooth enamel.

Rogers is frustrated by what she calls “false and misleading” information provided by town leaders, dentists and doctors in letters to the editor and at public meetings. Comments by those people that fluoride is a natural mineral “makes people think it’s just like adding vitamin D to milk or iodine to salt,” she said.

“Those people have a choice to buy those supplemented items,” she said. “We who are paying for the town water don’t have a choice to opt out.”

IN THE INTEREST OF PUBLIC HEALTH

Residents and health officials who support it say the public health benefits outweigh concerns that are not backed by science.

Wendy Wolf of Boothbay Harbor is a pediatric cardiologist and former CEO of the Maine Health Access Foundation who has been speaking publicly in favor of continuing with fluoridation. Good dental and oral health are very important overall for children’s health, she said, and she has seen patients experience serious health issues that stemmed from cavities and abscessed teeth.

Maine’s shortage of dentists and dental hygienists coupled with the rural nature of the state makes it hard for many families to access adequate dental care, but water fluoridation can help prevent dental disease, Wolf said.

“It’s something we can do in the community that helps every child and does not have to rely on personal responsibility to ensure kids have every chance to have healthy teeth and are spared the burden of dental disease,” she said.

Dr. John Andrews, whose dental practice is in Boothbay Harbor, said during the public hearing that he helped add fluoride to the water supply nearly two decades ago and still sees the benefits for his patients of all ages. He said he “firmly believes” fluoridating water is the right thing to do.

“Anything we have in our toolkit to help is beneficial,” he said.

Fluoride does occur naturally in some water, but environmental testing of the region’s water sources – Adams Pond and Knickerbocker Lake – have never shown detectable levels of fluoride. That requires additional fluoride to be added to drinking water at the Adams Pond Treatment Plant, according to Jonathan Ziegra, general manager of the water district.

Ziegra said the water district has not taken a position for or against the Nov. 8 referendum because it believes the decision should be made by residents.

The water district uses sodium fluoride, which is certified by the National Sanitation Foundation.

“In its pure state, sodium fluoride, an odorless, white crystalline powder, is a very toxic chemical, requiring, specific training for handling, special personal protective gear, and tight, secure control of pure chemical in storage,” Ziegra wrote in a letter to the editor published last week in the Boothbay Register.

Since discussions about water fluoridation began earlier this year, Ziegra has fielded only a few questions from residents about the process.