Supporting the initiative for fluoridation is Citizens Promoting Dental Health while Juneau Citizens for Safe Water oppose the method. The issue started more than two years ago when a public works employee stopped adding fluoride to drinking water because it was thought to be eroding city pipes. When area doctors and dentists learned the program had ceased, they successfully argued that it be resumed. A task force was later appointed by the Assembly to study fluoridation and was split on the issue. In November the Juneau Assembly voted 4-5 against fluoridation. Ketchikan and Haines also do not fluoridate public water.
However, some citizens were concerned about the affects of such a decision and wanted the issue to be voted on by the general public.
"It's extremely important that there be fluoridation in the water because fluoridation provides dental caries (cavities) prevention to everybody across the spectrum regardless of money and ability to have insurance. It's an equity issue," said Dr. carolyn Brown, a Juneau physician. "I felt like the people didn't get to decide for themselves and that's why I felt that it was important this be on the ballot."
Dr. Emily Kane, a Juneau citizen who practices naturopathic medicine, served on the city's fluoride committee and is now a member of Juneau Citizens for Safe Water. She said that while there may have been a case for fluoridation in the past that doesn't mean it is safe.
"Scientific information changes. What was true in 1950 might not be true in 2007. Look at things like mercury, tobacco, hormone replacement therapy," Kane said.
"If you look at the big picture, it seems immoral to use this excuse of way back in the 1950s we noticed a correlation between communities with natural fluoride and those without it. There are holes in that plan."
Grant Ritter, chair of the anti-fluoridation committee and former head of CJB Water Department, said fluoride has no place in the public water supply.
"Fluoride itself is a toxic poison. We're doing everything we can to keep people away from lead and here is something more toxic, and they want to put it in the water," Ritter said.
He said to administer fluoride to water, employees were required to wear a chemical apron, rubber gloves, a respirator and eye protection before pouring the substance into the water.
"On those bags there's a statement - Fluoride: do not ingest," he said.
However, Brad Whistler, a dental officer for Alaska Department of Health and Social Services and pro-fluoride committee member, said fluoride is safe in the proper levels.
"The opponents are often failing to state where we're talking about fluoridation at one level, the reports they cite focuses on a level four times the rate recommended for water fluoridation," Whistler said. "In terms of fluoride being a toxin or poison, any substance at high levels is a toxin or poison. The bags of sodium fluoride are labeled as a toxin or poison. Certainly if you were consuming fluoride right out of the bag, it would be a toxin because that's a lot of fluoride. That's not what we're talking about. We're talking about fluoride in the water at one part per million, which is like an inch to a mile or a drop in 40 gallons of water. It's not a lot of fluoride we're talking about in the water, and at that level it's not a poison."
Ritter said fluoride shouldn't be added to the water when the dosage can't be adjusted for each person.
"You can't get a prescription from a doctor you haven't seen, and that's what this is," Ritter said. "Topically it's OK. You don't want to medicate people through the water system. It's the wrong stance to take."
Whistler said that simply brushing with fluoridated toothpaste is not enough and fluoride in the water has a continuous affect because it works in the saliva after water has been consumed.
"The misperception is because you drink water and you swallow it that it's only the topical affect of fluoride in the mouth to remineralize the teeth," Whistler said.
Another point of contention is a recent American Dental Association report that cites the effects of infants overexposed to fluoride. According to a study by Oregon State University's Linus Pauling Institute micronutrient research for optimum health, dental fluorosis is the result of excess fluoride before the eruption of permanent teeth, usually before a child is 8 years old. The condition features mottling and mild staining on teeth. According to the study, mild to moderate dental fluorosis occurs when the intake of fluoride by a young child is two to three times more than the recommended amount.
While fluoride in water could exceed suggested levels, the study also suggests this condition can occur when children swallow toothpaste before permanent teeth appear.
Karen Lawfer, spokesperson for the pro-fluoride committee and a Juneau parent, said that while the ADA report did raise concern about infants under six months of age getting too much fluoride, it is a cautionary step.
"There is fluoride in formula and when you mix it with fluoridated water you may have a risk. Talk to your doctor to see if you're giving a baby a higher level of fluoride than is recommended," Lawfer said. "It's not a medical problem per se.
"It just a situation that the ADA wanted to make sure doctors and dentists were talking to their patients. They weren't saying stop fluoride, they just wanted to make sure this was addressed."
Juneau lawyer and judge Mary Alice McKeen said she is concerned about infants, especially in the low-income bracket, being over exposed to fluoride should water fluoridation occur.
"Breast feeding is best but a lot of people don't breastfeed. If you put fluoride back in the water, the kids who have parents who are health conscience are going to benefit. The kids getting fluoride are those whose moms don't breastfeed and are going to give their kids formula mixed with tap water," McKeen said. "I'm really worried about low-income children - babies - because they're the ones who are going to get the fluoridated water. I'd rather see us put the effort in teaching people good dental hygiene rather than teaching people not to be able to use the formula. The solution is not infants not using the tap water, but having tap water that everyone can drink."
Kane also thinks education efforts are a better solution rather than fluoridated water. She said teaching children healthy eating habits and good dental hygiene is a way to prevent dental decay without using fluoride. She also suggested using money that would go to having fluoride rinses offered at the schools.
"I think people would be happy with that. It strikes me as a fair compromise," Kane said. "It's actually a more accurate way to use fluoride as a dental hardener."
Whistler said the problem with alternative programs is the "high compliance issue."
"If you're doing fluoride supplements you need to give your children a supplement every day from the time they're six month old to the time they're 16 years old to that effect, and that's pretty hard to do," Whistler said. "Another thing is that if you look in Juneau now, we discontinued fluoride on Jan. 15. I have not seen a movement for those alternative programs to move forward in our schools or with our seniors or other populations in the community."
Brown said fluoride does not only affect children, but also has an impact on senior citizens.
"For older people, gums recede and expose the roots of their teeth then they're more at risk for oral disease, and it's just a mess. They can't eat and if they can't eat, their nutrition is bad and then other aging diseases become worse," Brown said. "We have to believe we cannot be separated from our teeth and our mouth because our mouth is kind of an entry of things that happen to us, and if that doesn't work - whether you're little or big or young or old - other things don't work."
Juneau chiropractor Dr. Birger Basstrup, said getting fluoride should be a personal issue and not something added to the water for everyone to ingest.
"It should just be given to people that need it, and this (water fluoridation) is like prescribing medicine without a license in a sense," he said.
Juneau resident Marilyn Holmes said she once worked as a dental assistant and believed in the use of fluoride, but changed her mind after becoming ill and tracing her symptoms back to fluoride.
"Complex problems have simple, easy to understand wrong answers," Holmes said.
Brown said the decision should be up to the citizens at large and is glad to see that the issue will be decided on in the municipal election.
"I'm encouraging people to think about what is being said, listen to the arguments and vote on Oct. 2," Brown said.
Although Basstrup does not favor water fluoridation, he does agree that people need to voice their opinions on the issue at the polls.
"I want for people to be open to information and research out there," he said.
"I just want people to listen with an open mind - for or against it - and learn something new."