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If the risks of water fluoridation are hotly debated, quantifying its benefits is also tricky. In the 1950s, advocates claimed a 60% drop in cavities. But with the spread of fluoride toothpastes and the use of plastic sealants by dentists, decay has plummeted even in regions where there is little or no fluoride in the water. A 2001 CDC study found that by the time they were 12, kids in fluoridated communities averaged only 1.4 fewer cavities than those in non-fluoridated areas. And even in fluoridated cities, severe decay remains rampant among the poor--partly because some 85% of dentists, according to state surveys, reject Medicaid patients. Still, for those with little dental care, water fluoridation makes a difference, contends Bellingham's Curtis Smith. "Twenty percent of our kids account for 80% of the cavities," he says. "With fluoride in the water, they would get a blast every time they drink."
But in parsing risks, Bellingham is also weighing an undisputed side effect of ingestion. The CDC recently announced that 32% of American children now have some form of dental fluorosis, a white or brown mottling of the teeth. U.S. health officials see it as a cosmetic issue, largely caused by ill-advised swallowing of toothpaste, while fluoride critics say it shows that children are accumulating too much fluoride overall. The World Health Organization sets a fluoride-safety standard of 1.5 p.p.m.--well below the EPA's 4-p.p.m. rule--partly to prevent enamel fluorosis. And in Western Europe, where the drop in tooth decay in recent decades is as sharp as that in the U.S., 17 of 21 countries have either refused or discontinued fluoridation, contending that fluoride toothpastes offer adequate protection. (Only Ireland adds fluoride to most of its water systems, while Switzerland fluoridates its salt.)
Those facts, recycled through Web-savvy organizations like the Fluoride Action Network, are stirring up activists. While city councils and water boards tend to fluoridate when they have the power, the electorate is far more divided. Over the past five years, the practice was voted down in 38 of 79 referendums, from Modesto, Calif., to Worcester, Mass. "The Internet is making it light-years more difficult to fluoridate," says Smith. The Washington State Dental Association is backing his $300,000 pro-fluoride campaign. Danelle Weaver and her friends, meanwhile, have raised less than $10,000. But they are undaunted. "People think we are tinfoil hatters," says Weaver, "but we're just average families who take the time to research and want what's best for our children." That goal is the only thing both sides seem to share.