From the tops of palm trees overlooking the Wakodahatchee Wetlands, birds make the loudest noise at the north end of Palm Beach County’s Water Treatment Plant No. 3.
In between the chirps, a rhythmic “swoosh” can be heard every few seconds from a tangle of pumps connected to two white outdoor tanks at the base of the trees. That’s the sound of fluoride — drip by drip — making its way into a system that generates 30 million gallons of drinking water a day.
There are similar fluoride-pumping systems in water plants around the county, giving more than 777,000 residents in eight communities — about 61 percent of the county — an edge in fighting tooth decay.
But to many people, the “swoosh” of the pumps west of Delray Beach is the sound of public mass medication with unknown and potentially hazardous long-term effects.
One pump was silenced last week after the Wellington council voted 3-2 late Tuesday to stop fluoridating its water. Wellington, which had been using fluoride since 2000, is the first municipality in the county to stop the practice.
“It’s very disappointing to me because as a public health dentist I really look at trying to prevent disease before it starts. This is an opportunity to do that. Fluoridation is very much a cost savings for the average citizen,’’ said Dr. Philippe Bilger, dental director for the Pam Beach County Department of Health.
The federal government says public water fluoridation can reduce tooth decay by 25 percent. But that hasn’t stopped opponents who say that excessive fluoride can lead to problems with teeth, bones and kidneys.
Since 2010, 70 communities — from Smithville, Mo., to Hamilton in New Zealand — have rejected public water fluoridation, according to the opposition group Fluoride Action Network. That includes at least 30 communities that voted to end existing programs.
Government health officials say those communities are misguided because there’s no evidence linking public water fluoridation with long-term health problems.
Fluoride occurs naturally in the county’s water supply at 0.2 milligrams per liter. The county’s fluoridation system increases that amount to 0.7 milligrams per liter, a concentration well within levels recommended by the U.S. Centers for Disease Control and Prevention.
The county fluoridates to its water system by injecting hydrofluorosilicic acid, a liquid chemical. The county adds other minute amounts of chemicals, including chlorine, ammonia and acid, to its water as part of the treatment and disinfection process.
From 2005 to 2011, the U.S. Department of Health and Human Services had recommended fluoride levels as high as 1.2 milligrams per liter. But that was lowered in 2011 to 0.7 to reduce the chances of children contracting mild dental fluorosis, which causes white or yellow spots on teeth.
Those risks are worth the benefits of public fluoridation in helping reduce tooth decay in people from all socioeconomic backgrounds, said Dr. Barbara Gooch, associate director for science in the CDC’s Division of Oral Health.
One CDC study found that in communities with more than 20,000 residents, every $1 invested in water fluoridation yields about $38 in savings every year from fewer cavities treated.
“When we look at the ethics of community water fluoridation, it is well established there are clear benefits and the risks are limited to mild fluorosis,’’ Gooch said.
Opponents argue that fluoride already is available in toothpaste and mouthwash. Adding it to public tap water makes it impossible to measure the effects on the entire body because people drink varying amounts of water.
“There are too many variables there (for public agencies) to be mass medicating everybody,’’ said Dr. Bill Osmunson, a Portland, Ore., dentist for 35 years and FAN spokesman.
While the CDC ranked public fluoridation as one of the greatest public health innovations of the last century, Osmunson predicted it one day will be regarded as “one of the 20th century’s greatest public-health blunders.’’
The fluoride debate isn’t new to Palm Beach County. After a contentious debate in 2003, commissioners voted to add fluoride to the county’s water system, a practice that started Jan. 14, 2005.
Commissioners voted again in 2006 after a National Research Council report called for additional research on public water fluoridation. Although County Administrator Bob Weisman recommended stopping the practice, commissioners that year voted 4-3 to continue adding fluoride into a system with 450,000 customers.
After Wellington voted last week to stop using fluoride, Weisman said he has no plans to bring the volatile question back for consideration. But he said his stance from 2006 has not changed.
“When you do read through the literature on this, there are things that give concerns about health effects. I believe there could very well be dental benefits, but the question of safety is still a bonafide concern,’’ he said.
Naomi Flack of South Florida Citizens for Safe Drinking Water included Weisman’s 2006 opinion in a memo she sent to Wellington council members last week.
“Please do not be swayed by endorsements by big name health agencies,” she wrote. “Common sense tells you that you cannot control the individual’s dose of a known toxin when you cannot control how much water people drink. This is medically unsound and also violates freedom of choice.”
In 1945, Grand Rapids, Mich., became the first public agency to fluoridate its water. That came before fluoride was readily available in toothpaste, which the CDC traces to the 1960s.
Decades earlier, government health officials had raised concerns about fluoride in public water before studying the issue to find acceptable levels, said Kip Duchon, the CDC’s national fluoridation engineer.
In 1951, the National Research Council issued the first recommendation for all communities with children to fluoridate public water supplies. Ever since then, CDC officials say, opponents of fluoridation have claimed it increased the risk for cancer, Down syndrome, heart disease, osteoporosis and bone fracture, AIDS and low intelligence.
The safety and effectiveness of water fluoridation have been reevaluated frequently, and no credible evidence supports an association between fluoridation and any of these conditions, the CDC said.
“If anyone started the controversy,’’ Duchon said, “it was the public health service making sure it did the right thing.’’
Meanwhile, one local public health official says Wellington officials will one day regret their decision.
“I think that’s going to affect the city of Wellington. There may be an increase in decay,’’ said Bilger of the county health department.
One retired dentist said he’s particularly disappointed by Wellington’s choice.
“They didn’t pay attention to the science they had. It’s hard for me to comprehend,’’ said Carmine Priore, a former Wellington councilman who voted to initiate fluoridation in 1999.
“We’ve had this in the water for 10 years and there hasn’t been anyone who has come forward and said it’s a problem.’’
Priore, who retired from dental practice in 1995 after 30 years, had some advice for the town.
“It should be incumbent on them to send out notices to parents that ‘your water is no longer fluoridated. Please see your pediatrician about receiving it in tablet form.’’’
Where the fluoride is
Water supplies for nearly 75 percent of Americans and 78 percent of Floridians are fluoridated. Miami-Dade County began fluoridating in 1952 and Broward County began in 1972. Here are figures for Palm Beach County cities:
Community /// Fluoridation start date /// Population served
Atlantis* Jan. 14, 2005 1,853
Boynton Beach Jan. 1, 2002 81,531
Century Village South* Jan. 14, 2005 8,303
Delray Beach April 1, 1991 66,648
Glades Utilities Authority** Oct. 15, 2008 30,299
Gulf Stream*** April 15, 1991 753
Palm Beach County Jan. 14, 2005 442,061
West Palm Beach**** July 1, 1991 100,245
* Receives water from Palm Beach County
** The Glades Utility Authority absorbed all of the following communities in 2008, but those communities
had earlier start dates for fluoridation as follows: Belle Glade, Nov. 1, 1956; Pahokee, Dec. 1, 1996; South Bay, Oct. 1, 1999; Lake Harbor, Oct. 1, 1999.
***Receives water from Delray Beach
****Also serves Palm Beach and South Palm Beach
SOURCE: Palm Beach County Health Department
How much fluoride?
The U.S. Environmental Protection Agency considers fluoride safe at 4 milligrams per liter of water.
In Palm Beach County’s system, the amount of naturally occurring fluoride is 0.2 milligrams per liter. The county adds 0.5 milligrams for a total of 0.7 milligrams — well below the EPA maximum.
What is fluoride?
A naturally occurring element that helps strengthen teeth and protect against cavities. It has been added to public water supplies in America since 1945. Opponents say excessive fluoride can lead to problems with teeth, bones and kidneys.