Dr. Elisabeth Warder can spot the difference between a Cheney resident and a Spokane resident by the sight of their smile.
As a longtime dentist with the nonprofit CHAS Health, Warder said the people of Cheney just have fewer cavities.
“Here in Spokane, we’re behind. We’re decades behind,” she said.
Warder was among three public health advocates who implored the Spokane City Council on Thursday to add fluoride to the city’s drinking water supply, citing the naturally occurring minerals’ benefits to dental health.
Unlike efforts to fluoridate water in the past, the advocates asked the City Council to skirt the ballot and instead enact an emergency ordinance that would require the drinking water’s fluoride levels meet federal recommendations.
Speakers highlighted the health care inequities exacerbated by the poor dental health of low-income people and persons of color, and the proven use of fluoride as “nature’s cavity fighter.”
The City Council did not take action on Thursday, but heard the request during a study session.
The plea from dentists and public health experts was just the latest in the city’s long debate over fluoridating its water. Supporters have attempted and failed three times to sway city voters to support the cause. Most recently, a bid to fluoridate the water was turned down, narrowly, in 2000. It was the closest attempt yet.
Those who oppose fluoridation often equate it with forced medication and claim it would be government overreach, or disbelieve the consensus of most medical and public health organizations that fluoride is safe at recommended levels.
According to the Centers for Disease Control and Prevention, water fluoridation is safe and “beneficial for reducing and controlling tooth decay and promoting oral health across the lifespan.” Fluoridation reduces tooth decay in children and adults by 25%, according to research cited by the CDC.
Spokane is the only city among the five largest in Washington that doesn’t add fluoride to the municipal water supply. More than 75% of the U.S. population drinks water that meets recommended fluoride levels.
Warder, dental director at CHAS, laid out the grim picture of dental health in Spokane. Four of every 10 kindergarten children in Spokane have had a cavity. One-fifth of third-graders have “rampant tooth decay,” she said.
“Historically, we’ve had a higher rate of cavities and other oral health problems than many other communities in our state,” Warder said. “Good oral health is not an individual issue, it is a public health issue.”
Dental health problems are higher among low-income people, many of whom lack access to dental care, Warder said. Health inequities start young, and painful cavities can make children more likely to miss school or struggle to pay attention, often resulting in lower grades.
“This just widens the inequities in health care and education,” Warder said.
The COVID-19 pandemic only adds to the urgency in adding fluoride to the water, argued Dr. James Sledge, a longtime Spokane dentist who served three terms on the Washington State Board of Health.
During the pandemic, Sledge said, it is “doubly important that we reduce the stress on health care workers and hospitals,” which is where patients without access to dental care often turn.
Warder echoed that concern.
“Many low-wage workers lost their jobs. During this tough time, poor dental health is just one more blow to these very vulnerable people in our community,” Warder said.
Spokane’s water naturally contains about 0.2 milligrams of fluoride per liter, so the city would need to artificially adjust it to reach the recommended 0.7 milligrams.
Sledge said the matter is a public health, not a political, issue and that state courts have recognized a city’s right to fluoridate its water as an administrative decision – without voter approval.
“Public health issues should not be political or divisive,” Sledge said. “We’d like to avoid that in our community.”
Councilwoman Lori Kinnear said it’s “too late” to avoid politicization.
“It’s already politicized. Wearing masks has been politicized. So I think that ship sailed,” Kinnear said.
A vocal contingent of people in Spokane has ardently opposed fluoridation. In 2010, a billboard on East Sprague Avenue decried fluoridation as “Public Health Quackery!”
The cost of implementing a fluoridation system in Spokane would be $4 million, Sledge said. Delta Dental has committed $3 million, and Sledge expressed confidence that “key funders and leaders will secure the balance.”
“Enacting a change like this could support the health and vitality of this community for generations to come,” said Priyanka Bushana, a graduate student of neuroscience at Washington State University.
For every dollar spent on fluoridation, a community saves an average of $32 in dental treatment costs among its population, Bushana said.
“That’s not even to mention the savings in the time, stress and overall health care that’s mediated by oral health,” Bushana added.
Bushana represented the Health Sciences Student Advocacy Association at WSU’s Health Sciences campus, which presented the council with a letter calling for fluoridation. It had more than 200 signatures from staff, students, faculty and members of the community.
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