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Ithaca’s Fluoride Debacle

Authored by Constance Newell, Biological Sciences '24

Art by Phoebe Ahn, Biology & Society '23

Ithaca, New York, is a frontrunner in combating many social issues, from being the first Ivy League to admit women, to being the first city to begin 100% decarbonization. Despite these admirable strides, Ithaca is decades behind when it comes to oral health advocacy. Of the 73% of Americans that have access to public fluoridated water, Ithacans are not among them [1].

The benefits of water fluoridation in reducing tooth decay have been documented through various studies, with one published in the Journal of the American Dental Association (ADA) analyzing data from 51 previous studies conducted in the United States. The study found that water fluoridation can lead to a reduction of tooth decay by 18-40% in children and adolescents [2]. This is further supported by the Centers of Disease Control and Prevention (CDC), which recognizes water fluoridation as one of the most significant public health achievements of the 20th century [3]. Despite the resounding endorsement from nationally recognized health organizations, Ithaca policymakers continue to stand their ground against water fluoridation.

Water fluoridation is a contentious issue in Ithaca, with a provision against government-sanctioned fluoride even existing in the charter of the city; Section 35: “...shall not enact or enforce any local law or ordinance or resolution for any purpose pertaining in any manner to the fluoridation of the water” [4]. On November 7th, 2000, the City of Ithaca held a vote on two propositions pertaining to fluoridation. The first ballot, which would amend the city charter to give the Common Council the power to fluoridate the water supply, was opposed by 52% of Ithacans. The second, which was a vote on the actual fluoridation of water, was opposed by 54% [5, 6]. This was the first and last time that a water fluoridation referendum was balloted.

Despite the overwhelming research detailing the benefits of fluoride, many maintain concerns about its safety. Staunch opponents of municipal water fluoridation argue that fluoride is a toxic substance that can cause a wide range of health problems, including dental fluorosis and neurotoxicity [7]. Although there is no scientific evidence linking fluoride to neurotoxicity, mild fluorosis is a common condition that affects roughly 25% percent of Americans between ages 6-49 [8]. Fluorosis is a dental condition that results in white speckles on the surface of the teeth in mild cases, and brown patches in more severe cases[9]. Although fluorosis is a prevalent condition, it is purely cosmetic and has no impact on oral health or tooth function. In fact, individuals with fluorosis are more resistant to cavities [8]. Fluorosis can be prevented by moderating fluoride intake in early childhood and most drinking water contains 0.7-1.2 ppm of fluoride, which is below the level of fluoride needed to cause dental fluorosis, 1.5 ppm [10].

Opponents of water fluoridation also criticize it as a form of forced medication that goes against individual rights. They argue that fluoride is the only chemical that uses municipal water supply as a vehicle for medication and that all other chemicals added are for water treatment [11]. Although compelling, this argument ignores the fact that foods and beverages are commonly fortified for public health interests - for example, the enhancement of salt with iodine, milk with vitamin D, orange juice with calcium and bread with folic acid. Furthermore, fluoride is naturally present in the ground water and the oceans. Water fluoridation is simply the adjustment of fluoride to recommended levels to prevent tooth decay [12,13,14].

A survey across upstate NY revealed that 28-38% of adults do not receive routine professional dental care[15]. This is concerning, as more than 90% of all systemic diseases induce oral symptoms that can be identified by a dentist during a routine oral exam, such as cancers, osteoporosis, AIDS, and anemia. Furthermore, poor oral health can lead to other health issues, such as diabetes and chronic heart disease [14]. Fluoridation of the Ithaca water supply would be a cost-effective way to provide equitable dental care. This would be particularly beneficial to those who may not have access to regular dental care or may not be able to afford comprehensive dental treatments. Furthermore, it is relatively inexpensive to add fluoride to water. The average lifetime cost per person to fluoridate water supply is less than the cost of just one dental filling. For most municipalities, every $1 invested in water fluoridation saves $38 in dental treatment. Fluoridating Ithaca waters would ensure that people from all walks of life have access to basic preventative care, regardless of their income or insurance status [16].

Despite the overwhelming evidence supporting the benefits of water fluoridation in reducing tooth decay, Ithaca remains one of the few cities in the United States that has not adopted this practice. The debate over water fluoridation in Ithaca has been contentious, with concerns about safety and individual rights at the forefront of the opposition. However, fluoridation of the Ithaca water supply would provide equitable dental care to all residents, particularly those who do not have access to regular dental care or cannot afford comprehensive dental treatments. It is a cost-effective way to prevent tooth decay and improve overall oral health, which is essential for preventing other systemic diseases. As such, it is important to urge policymakers in Ithaca to reconsider their stance against water fluoridation and work towards promoting oral health for all residents.

Works Cited

  1. United Health Foundation (2023). Water Fluoridation in United States. America’s Health Rankings.

  2. Griffin, S. O., Regnier, E., Griffin, P. M., & Huntley, V. (2007). Effectiveness of fluoride in preventing caries in adults. Journal of dental research, 86(5), 410–415.

  3. CDC (1999, December 24). Ten Greatest Public Health Achievements-United States. CDC.

  4. City of Ithaca (1997). The Charter. Article V. C-61. A1.

  5. Friedlander, Blaine (2000, November 3). Despite Vocal Opposition, fluoridation of Ithaca water expected to pass on Nov. 7, Cornell student poll indicates. Cornell Chronicle.

  6. Bogel-Burroughs, Nicholas (2015, August 17). Explainer: 6 questions about Ithaca’s decades long fluoride debate. The Ithaca Voice. (

  7. Connet Paul H., Beck James S., Micklem H.S. (2010). A Case Against Fluoride: How Hazardous Waste Ended up in Our Drinking Water and the Bad Science and Powerful Politics that Keep it There. Chelsea Green Publishing.

  8. Cleveland Clinic (2023). Fluorosis. Cleveland Clinic.

  9. NYC Environmental Protection (2023). Water Service Disruptions Drinking Water FAQs. NYC.GOV.,Fluoridation%20began%20in%201966

  10. CDC (2023). Public Health Service Recommendation. Centers for Disease COntrol and Prevention. CDC.,per%20liter%20of%20drinking%20water.

  11. FAN Staff (2000, October 21). Ithaca’s Fluoridation Debate. Fluoride Alert- Fluoride Action Network.

  12. National Fluoride Advisory Committee (2018). Fluoridation Facts. American Dental Association.,Fluoridation%20began%20in%201966

  13. Association of State and Territorial Dental Directors (2016, September 14). Fact Sheet- Natural Fluoride in Drinking Water. ASTDD.

  14. ADA (2023). Fluoridation in Water. American Dental Association.

  15. Excellus BlueCross BlueShield (2018, September 25). Survey of dental care across upstate NY found many adults did’t visit a dentist in the past year. BlueCross BlueShield.

  16. Ko Lee, Thiessen K.m., (2015, March). A Critique of Recent economic evaluations of Community Water Fluoridation. National Library of Medicine. Int J Occup Environmental Health. 21(2): 91-120. doi: 10.1179/2049396714Y.0000000093

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