Correction added April 26: Harvard researchers said a 2012 analysis showed that high fluoride exposure caused a seven-point IQ decrease. The story is corrected below.
TYRONE - Borough Council voted March 11 to remove fluoride from the water supply, reversing its 1994 decision to add it.
The vote came quickly and without any community or medical input, leaving lingering questions about the reason behind the decision.
Mirror photo by Patrick Waksmunski
Bellwood dentist Dr. Don Miller examines the teeth of Kobe Mannino, 9, of Tyrone. Borough Council voted in March to remove fluoride from the water supply, causing divisions among some residents over the decision.
There were no mentions of conspiracy theories or secret government plots, as has come up in other defluoridation controversies across the country, but at least one councilman said he'd seen documentaries revealing fluoride to be a poison and wanted to see it removed from the water supply.
Council members Christy Ray and Courtney Rhoades voted against the measure, asking others to wait until a dentist could advise them.
What comes next will be a round of community notifications set to go out at the end of this week with residents' water bills while borough officials obtain Department of Environmental Protection approval.
The change likely won't take effect until the end of summer, but many said the decision was a long time coming.
Water Department Superintendent Ardean Latchford said fluoridation had been debated among residents and even council members for awhile.
"We were at the point that we had to make a decision," Latchford said.
Borough Mayor Bill Fink has been particularly vocal on the issue, telling council members a combination of outside medical information from funeral home directors and borough residents, along with his own health changes, prompted his vote.
He's also said that fluoride is a poison and, while fluoride is beneficial - and especially so for young children with developing teeth - government officials should not play doctor.
According to the Fluoride Action Network, nearly 70 communities - about a third of them in the U.S. - have voted since April 2012 to remove fluoride.
What makes Tyrone's decision unique is that despite what council called communitywide support, not a single borough resident has brought the issue before them. No one representing either side of the issue showed up for the March or April meetings.
Making the case
Opposition to "mass medicating" a community was one of the main factors behind a 2007 decision by the Altoona Water Authority not to begin fluoridating its water, a significant blow to Altoona Regional Health System's Partnership for a Healthy Community, whose members had been pushing for fluoridation for years.
Partnership Dental Director Dr. Donald Betar was one of the first people who approached the Altoona Water Authority to discuss fluoridation.
"We were disappointed it didn't get through," he said, adding that tooth decay is the No. 1 infectious disease affecting children and having fluoride in the water is a way to protect kids.
Fluoride "by itself doesn't have everything," Betar said, but it's part of a tool kit that helps combat tooth decay. Parent, pediatrician and school involvement, as well as regular dental checkups, also are part of that tool kit, he said.
Although critics say fluoride works best topically, not from ingestion, he said fluoridated water will become part of the chemical makeup of a child's saliva and part of the jaw structure to strengthen teeth as they develop.
According to the Centers for Disease Control and Prevention, more than 66 percent of the U.S. population receives fluoridated water.
When the issue was brought before authority members, none of the backlash came from members of the scientific community, he said, but from people who believed either that fluoride is a secret communist plot, or that government and hospital officials were seeking to dump unwanted chemicals.
General Manager Mark Perry said while authority members carefully studied the topic, its opposition came out in full force to meetings, with people bringing anti-fluoride literature and "3-inch books about fluoridation, and encyclopedias."
Perry said board members were open to public comment but ultimately decided to take a basic approach.
"Our mission is to provide a clean, safe water supply," he said. "We're not a delivery system" for additives like fluoride or other unnecessary chemicals.
Betar also admitted that with fewer people drinking tap water, fluoride's benefits often aren't being delivered to its intended recipients.
Partnership board members have considered broaching the topic again, Betar said, but there are a lot of considerations to weigh because people have such volatile reactions to fluoridation.
If Tyrone Council members end up changing their minds, he said, that could be a catalyst for change in Altoona.
The good and the bad
There is a lot of thoroughly researched scientific evidence on fluoridation's side.
The CDC named water fluoridation one of the 10 great public health achievements of the 20th century. It also is endorsed by the American Medical Association, the World Health Organization and the National Research Council.
But there also is a downside, and many who are anti-fluoride said this information is swept under the rug, ignored by dentists and doctors.
A 2010 study published in the Journal of the American Dental Association reported that infants are at a high risk of fluorosis, a condition caused by excessive exposure to high concentrations of fluoride that could result in mild staining or even tooth mottling.
Cases in America are more rare, and the result usually is cosmetic: white stains or streaks on the enamel, which can sometimes be fixed with tooth whitening or bleaching.
But in extreme cases, especially in children 8 and younger, high fluoride exposure can irreversibly pit the enamel.
Fink cited some of these studies at council meetings, and Latchford said mothers may be using tap water to mix with their baby formula, unaware that it can have negative consequences.
"If we take it out" they won't have to worry, Latchford said.
Looking at the data
One high-profile case cited by anti-fluoride groups comes from a 2012 study published by the National Institute of Environmental Health Sciences in its peer-reviewed journal dealing with a Harvard review of developmental fluoride neurotoxicity.
Researchers looked for whether a pattern exists between children's exposure to fluoride and lower IQ scores by looking at 25 studies in China and two in Iran where children were exposed to high fluoride levels.
The team found that high-fluoride exposure caused a seven-point IQ difference.
But pro-fluoride groups have pointed out significant drawbacks to the study: First, the studies were conducted in places where fluoride is not regulated; second, in three of the studies children were exposed to fluoride from coal-burning fumes, not tap-water ingestion; three, some of the fluoride concentrations were two or three times higher than the EPA's maximum level; and four, the researchers admitted that their results could have fallen within the measurement error of IQ testing.
The researchers concluded, however, that fluoride toxicity in children can occur at levels significantly lower than in adults, and even a small shift toward lower IQs would have a substantial impact on a population.
More research on fluoride-neurological connections should be conducted, they said, and in the meantime the EPA has been looking into lowering its maximum contaminant level goal for fluoride.
The agency first set its four parts per million standard in 1986, with a secondary standard of two parts per million to encourage communities to keep fluoride within that level and prevent mild fluorosis and keep fluoride from changing water's taste, color or odor.
But the U.S. Department of Health and Human Services now recommends lowering the level to 0.7 parts per million, with the backing of both the National Research Council and National Academy of Sciences, studies from which have shown a lower level could prevent bone fracture risk because it would be less fluoride exposure over time.
The borough is fluoridated at a maximum of two parts per million, but a 2011 water report stated detections ranged only from 0.43 to 1.41 parts per million.
Despite some conflicting research, dentists and several health organizations continue to recommend communities fluoridate water supplies.
Local American Dental Association contacts opposed removing fluoride, and Dr. Don Miller of Bellwood said researchers continue to look at its effects and change their stance as needed.
"It shows, to me, that they're paying attention to it," he said.
Miller also noted that because people can get fluoride from other sources, with some children getting it through school programs and others ingesting it with food, scientists can change the amount.
But claims that fluoride is dangerous have no evidence to back it, he said.
"I'm not so naive to say ... that our capabilities of measuring things in the future won't show something," he said, but some people are making "pretty outrageous claims" about fluoride now.
Miller said he can see Fink's point that there should be less governmental intervention, but said at some point those arguments become moot.
"Chlorine [in the water] is so successful. ... Where were [council members] when they started putting chlorine in?" Miller asked.
The jury's still out
In the end, Fink said, he is sticking to his vote and wants to see fluoride removed.
He said he's discussed fluoridation with area dentists, and while they disagree with his views on fluoride itself, he said they understand his stance that the government shouldn't be involved.
Longtime resident John Dearing said Friday he remembered hearing complaints when fluoride first was introduced.
"They thought it would ruin the water supply," he said, adding that he doesn't know anyone talking about the issue now.
That widespread apathy may be what's keeping residents away from commenting at council meetings on the matter, but some said they still care about keeping fluoride in the water.
Resident Jennifer Irons said she took her two children: Reagan, 8, and Drew, 4, to an Altoona dentist just a few weeks after council's vote and asked what he thought about fluoride.
"He said [fluoride is] a good thing," she said, and added that she cooks with her tap water and her children drink it.
She doesn't think fluoride should be removed, she said, because the amount in the water is so little. However, she said with two young children, it would be difficult to make it to a council meeting to tell its members her feelings.
Councilman Raymond Detwiler admitted that the issue doesn't mean that much to him; he said he voted to remove fluoride because he knows people can obtain fluoride from their dentist and get it from toothpaste, and wanted to support council's majority.
However, he said that he would be willing to change his vote if borough residents make their concerns known to him at the May or June meetings.
"If people want it in, they're going to have to show up and tell me they want it," he said.
Mirror Staff Writer Kelly Cernetich is at 946-7520.