Dr. Bill Collins, dental director at Red Bird Mission in Eastern Kentucky, said too many children in rural areas on well or cistern water lack access to fluoridated water and suffer much more from dental decay as a result. (Photo by Deborah Yetter for Kentucky Lantern)

As a dental hygienist working with low-income schoolchildren in Louisville, Jennifer Hasch said the untreated tooth disease she saw was shocking.

Some teens had decay so severe they had to have all their teeth pulled and be fitted with dentures. Middle school kids reported being unable to sleep because of pain from infected and abscessed teeth. First and second-graders required in-patient oral surgery under anesthesia because of the severity of tooth and gum disease.

“It was heart-wrenching,” said Hasch, who’s on the steering committee of the Kentucky Oral Health Coalition.

Adults don’t fare much better.

Kentucky ranks 49^th in overall oral health and is among the top states in the number of toothless, older adults. And last year, a University of Kentucky oral health physician described to legislators patients being air-lifted to the UK hospital because of life-threatening infections from dental disease.

Yet a group of lawmakers led by Rep. Mark Hart, R-Falmouth, is pushing a bill to make fluoridation optional for local water districts, despite what Hasch and others, including the American Dental Association and the Kentucky Dental Association, say is overwhelming evidence fluoride safely helps reduce tooth decay.

“It’s a bill that will undo an unfunded mandate and return the issue to local control,” Hart said, speaking before the Feb. 7 meeting of the House State Government Committee in support of House Bill 141.

Hasch and other oral health professionals are fighting HB 141, which would eliminate the water fluoridation mandate established in 1954.

“There are kids that already are suffering,” Hasch said. “Water fluoridation protects that from getting worse.”

Dr. Stephen Robertson, executive director of the state dental association, urged lawmakers to reject HB 141, saying “Kentucky is not in a position to take a step backward in oral health.”

“Please listen to our professional advice and continue to provide consistent fluoride access to our patients in community water supplies,” urged Mary Ann Burch, representing the Kentucky Association of Dental Hygienists.

They didn’t.

Instead, the committee approved HB 141 by a vote of 16-1, framing it not as a public health issue but rather one of local autonomy. The bill now is pending in the House.

“This is a local control issue,” said co-sponsor Rep. William Lawrence, R-Maysville. His city was the first in Kentucky to add fluoride to its drinking water supply in 1951.

“Local control — that’s what this bill is about,” said Rep. Steve Rawlings, R-Burlington, also a co-sponsor.

“Let’s just leave it to local control,” said Rep. Kevin Bratcher, R-Louisville.

In all, six members of the committee cited “local control” as grounds for passing HB 141. Rep. Keturah Herron, D-Louisville, cast the only no vote.

‘Setting my hair on fire’

The prospect of allowing local water districts to eliminate fluoride from drinking water has Kentucky dental and public health officials frantic.

“Other than setting my hair on fire, there’s not enough words I can say that this is a critically important step, if Kentucky takes it, to harm developing teeth, children’s teeth and adult teeth,” Dr. Connie White, Kentucky’s deputy public health commissioner, said on a recent call with health advocates.

Fluoride reduces cavities by 25%, White said.

Not only will it lead to even more tooth decay than Kentucky already has, White said, it will drive up costs of Medicaid, a government health plan for low-income individuals that covers nearly half of Kentucky’s children.

Filling one cavity in a child costs Medicaid about $250, which could add million of dollars to the cost of the program, White said.

Already facing a shortage of dentists in the state, especially pediatric dentists, removing fluoride from community water supplies will mean longer delays in care, Hasch said.

“We don’t have the resources to handle that increase,” Hasch said. “All these dental providers are desperately trying to catch up with the current need.”

Dr. Bill Collins, a longtime dentist in Eastern Kentucky, said too many children in rural areas on well or cistern water already lack access to fluoridated water and suffer much more from dental decay as a result. Compounding the problem is high use of sugary sodas and lack of access to oral health care throughout the state.

He said he’s baffled about why lawmakers want to remove the fluoride mandate.

“They don’t see the need for fluoride because they haven’t experienced the decay that we have out in the rural areas,” said Collins, director of the Red Bird Mission dental clinic in Beverly. “If this happens, they’re going to experience it and they should be held responsible.”

‘Grounded in science’

Fluoride, hailed as one of the major public health advances of the past century by the U.S. Centers for Disease Control and Prevention, was first introduced in Kentucky in the early 1950s and its statewide adoption has made Kentucky a national leader, advocates said.

A naturally-occurring mineral, added to water in small amounts, it helps strengthen tooth enamel and prevent decay, said Hasch. It helps when children’s teeth are developing but the main benefit is topical exposure to fluoride from drinking treated water.

The recommended level is .7 parts per million, which Hasch said is comparable to adding one drop of fluoride to around 11 gallons of milk.

The Louisville Water Co., the state’s largest public water provider, has been adding fluoride to water it gets from the Ohio River since 1951, said spokeswoman Kelley Dearing Smith.

The river water already contains some natural fluoride and the water company adds enough to bring it to the recommended level, she said.

“We are grounded in public health,” she said. “Everything we do is grounded in science.”

The Louisville Water Co. joined insurer Delta Dental of Kentucky, the dental and dental hygienists associations, the Oral Health Coalition and the Kentucky Primary Care Association in a letter to legislators urging them to reject HB 141.

“Community water fluoridation is a safe, reliable cost-effective prevention measure to keep teeth strong and reduce cavities by at least 25%,” the letter said. “…We are deeply concerned about any efforts to make water fluoridation programs optional in our communities.”

‘Forced medication’

Yet questions about fluoride’s safety and efficacy have persisted over the years, despite evidence to the contrary.

Four rural water districts submitted letters in support of HB 141: the Grayson County Water District, Irvine Municipal Utilities, the Martin County Utility Board and the McCreary Water District.

“The facts are out there proving fluoridation of water is dangerous to human health,” said the letter from Craig Miller, division manager for the Martin County water utility.

He also said it would save Martin County about $14,000 a year in fluoride costs, money he said could be better spent upgrading the problem-plagued water system.

Nina McCoy, a longtime activist for better water in Martin County and a member of the utility board said she wasn’t consulted on HB 141 and the board didn’t vote on the matter.

She suggested legislators defer to public health officials.

“I don’t pretend to be an expert in this at all,” she said.

A letter from Stephen Whitaker, superintendent of the McCreary water district, cited potential “adverse effects of fluoridation” including thyroid, tooth and bone problems.

Lawrence, a co-sponsor of HB 141, called adding fluoride to water “forced medication.”

Hasch, with the Oral Health Coalition, dismissed claims of studies linking water fluoridation to health problems as “junk science” and said the overwhelming body of research supports it as safe and effective.

Collins, who has practiced dentistry in Eastern Kentucky for more than three decades, said he doesn’t understand persistent distrust of fluoride.

“I really don’t understand why they are so adamant about removing this,” he said. “It’s something that’s time-tested and shown to be a good thing and it’s safe. It’s just mind boggling.”