IF FLUORIDE FAILS at the ballot box later this month—an incredibly distinct possibility, and something of a tragedy for Portland—it won't be because of the kooks and the conspiracy theorists who've spent decades stoking panic about a safe, tested, and effective health measure.

That ugly strain of paranoia is a well-known fluoridation killer, and maybe it helped kill fluoridation the other three times Portland said no. But this time? If anyone deserves blame, it'll be your neighbors—your very regular and very well-meaning neighbors.

The simple and reasonable case for fluoridation—which the federal Centers for Disease Control and Prevention (CDC) definitively urges for the prevention of tooth decay in children and adults—is drowning under a hailstorm of counter-arguments that look, sound, and seem rational. Except that they aren't.

And it's understandable. We're scared of junk science that we're too busy to tear apart. And we're worried about one of the things that Portlanders hold at the center of our civic identity: our water. So we rage about lobbyists and we put up signs that tell people not to do something that practically every other major city in America has done, some for decades and none with any sign of catastrophe.

Never mind that many of you who might be leaning toward "no" won't be the ones who suffer: it'll be poor kids whose lives are more complicated than "why don't they just brush more?" Make no mistake—those who vote "no" will be voting against the class of people Portland is famous for supporting.

It doesn't have to be this way. Portland can still make a rational choice come May 21. We're not gunning for a Pulitzer Prize, like the Tampa Bay Times, which won journalism's top award last month for a series of editorials staunchly defending fluoridation and debunking its myriad myths. But we can do our part for Portland.

Because those sane-sounding anti-fluoride arguments you've been turning around in your head? They're wrong.



  • Illustration by Alex DeSpain

Neither side likes cavities. They hurt like a bitch and make kids cry. And considering the amount of sugar in everything these days—yikes. But are masses of children in our community actually suffering?

Anti-fluoride groups claim that (1) any dental health epidemic in Portland is over-stated, and (2) that the only real solution for improved dental health is more access to health care.

But there IS a problem. A state survey of public schools found that 50.7 percent of kids in Multnomah County have already had a cavity (this number is higher among lower-income kids). Worse, about 20 percent of kids have to tough it out and leave their dental decay completely untreated.

Even if water fluoridation isn't a miracle cure, it definitely helps. According to the CDC, it can effectively prevent tooth decay. Bacteria in your mouth cause tooth decay. Bacteria make acid. That acid eats the minerals on the tooth's surface. Fluoride (a mineral), helps revitalize that surface. Having frequent, low-level contact with fluoride keeps that process regular. And given that it's politically unlikely taxpayers would support any major outlay for health care costs, why not pony up the couple bucks a year it'll cost for fluoridation (really, just $3 for the average household)? Because it will actually help.



  • Illustration by Alex DeSpain

For some skeptics, including groups like our local Sierra Club chapter, it's not about the science of dental care and what seems like a dizzying array of studies saying incrementally different things about fluoride's supposed sins and blessings. It's about water. Portland's water—unfiltered and drawn straight from the snow-kissed runoff that feeds the primeval Bull Run watershed.

So why in the world would we want to foul up such purity by squirting in an industrial chemical, fluorosilicic acid, better kept in some kind of hazmat vat? Because we already do. And most likely you can't even tell. The only "pure" thing about our water is the myth we're clinging to.

Upstream, where animals live and don't give a hoot about our crinkled noses, Bull Run water picks up fallen leaves, piss, shit, and even, occasionally, corpses. Because, you know, nature.

Then, as it makes its way inside Portland Water Bureau's "Headworks" water-intake facility, the city deliberately adds more nasty bits. Chlorine and ammonia help disinfect the water. And sodium hydroxide—AKA lye, an alkaline industrial salt so toxic you can't touch it—balances the water's pH levels to keep it from wearing out our homes' lead and copper pipes.

David Shaff of the water bureau says tours are rarely allowed at the Headworks. When they are, the presence of 36 tons of liquid chlorine means visitors must carry respirators and be advised of potential escape routes.

"What you get in your tap is a manufactured product," Shaff says. "It is not pristine water out of Bull Run."

(Oh, PS: Portland's water already has a trace amount of naturally occurring fluoride.)



  • Illustration by Alex DeSpain

No. They won't. But Portland is a beverage mecca, so we get that this is a crucial point: Let's not eff up the water supply, because nobody wants beer or coffee that tastes like a pool. Luckily, fluoride is tasteless and odorless. Blind taste tests have shown no humanly distinguishable difference between fluoridated water and distilled water. Alex Ganum of Portland's Upright Brewing wrote a letter to the Oregonian last year reminding us that if you drink beer from Corvallis or from outfits like Astoria's Fort George Brewery, you've already had fluoridated beer. The US Department of Agriculture keeps a list of nationally distributed foods and beverages bearing fluoride: among them Coke and Pepsi products. No, you couldn't tell. Best was a brewery in Utah that put the thesis to the test after its water was fluoridated, according to Bon Appetit. Once more, no one could tell the difference.



  • Illustration by Alex DeSpain

On the off chance you're five years old and reading this paper, first sterilize your eyeballs and then ingest some fluoride. The American Dental Association notes that a reasonable level of fluoride, ingested while teeth are forming, "is deposited throughout the entire surface of the tooth and contributes to long-lasting protection against dental decay."

Which is a long way of saying that while topical applications work well, drinking fluoride is hardly useless.

"We know that fluoride is effective when you consume it and it works systemically, and we know that fluoride is effective when it's applied topically," said Dr. Philip Wu, a Kaiser pediatrician speaking at a recent event for the political action committee (PAC) running Portland's pro-fluoride campaign, Healthy Kids, Healthy Portland. "The beauty of water fluoridation is it does both."

The point is: If you ingest it as a child, there can be huge benefits. Ingestion doesn't pay off as much for adults or people with adult teeth. Citing a 1990 study, the CDC points out that the amount of fluoride secreted in the saliva of people in fluoridated communities is negligible—probably not enough to ward off decay. But the organization also says the mere act of drinking a glass of fluoridated water raises the fluoride in your saliva for an hour or two. This, according to the American Dental Association, "continually bathes the teeth, providing a reservoir of fluoride that can be incorporated into the tooth surface to prevent decay."



  • Illustration by Alex DeSpain

Here's the thing: At elevated levels, fluoride is toxic. In high enough levels, so are vitamins D and A.  Too much oxygen can take you out. No large amount of any chemical or compound or element is going to be blithely accepted by your system.

Here's the other thing: The symptoms and conditions that fluoride skeptics often point to aren't a problem at the 0.7 parts per million (ppm) level Portland's proposing. Many of them aren't clearly a problem at all.

The rundown of maladies you've probably been warned of by now is too long to fully document here, but here are a few.

Bone weakness: If you ingest excessive amounts of fluoride over long periods, you're more likely to have broken bones—or even a nasty bone thickening called "crippling skeletal fluorosis." But once again, no one's talking about excessive amounts of fluoride.

A 2001 study in China, published in the Journal of Bone and Mineral Research, found "the prevalence of overall bone fractures is the lowest for populations living in areas of approximately 1 ppm of fluoride." That's more than Portland's proposing. The study, by the way, also found broken bones increase in places where fluoride amounts are very low.

"But our hips!" skeptics might protest. They'll point you to a 1992 study that suggested fluoride led to increased hip fractures in Utah's elderly. Other studies found differently. A 1993 study from Canada concluded "fluoridation of drinking water has no impact, neither beneficial nor deleterious, on the risk of hip fracture." A Minnesota study the same year concurred.

Cancer: There's just no concrete evidence fluoride causes cancer. People may reference a Harvard study that suggested fluoride could inspire higher rates of bone cancer in boys—but even the study's authors cautioned the need for further research. Another study found "no significant association between bone fluoride levels and osteosarcoma risk."

As the American Cancer Society points out, "The general consensus among the reviews done to date is that there is no strong evidence of a link between water fluoridation and cancer."

Dental fluorosis: This is a change in the appearance of teeth that can occur when still-forming teeth are exposed to fluoride. Again, it's associated with higher-than-optimal fluoride levels. At its worst, severe fluorosis involves brown stains on weakened teeth. That takes a great deal of fluoride exposure, though. Much more common, says the American Dental Association, are very mild cases involving hard-to-notice white flecks on some teeth. It comes down to being thoughtful about how much fluoride your young child ingests.

Under-active thyroid, calcium-filled pineal glands, weakened sperm, insomnia, skin rashes, etc.: What's that they say about proving a negative? Any discomfort can and will at some point be linked to fluoride exposure.



  • Illustration by Alex DeSpain

Some dentists and medical professionals do oppose fluoridation. Some, like Portland dentist Jay Harris Levy, will speak eloquently—uninterrupted for many minutes—on a slew of studies and the mass toll they feel fluoride's having on society. But there's hardly a schism. These folks are in the vast, vast minority.

Most of the groups listed as supporting anti-fluoride PAC Clean Water Portland are environmental and neighborhood organizations. Oregon chiropractors and acupuncturists also are opposed. Contrast that with the groups backing Healthy Kids, Healthy Portland: a litany of local and national dental, pediatric, and other health care organizations too long and comprehensive to list here.

Clean Water Portland makes a show on its website of having the support of "over 60 Portland doctors," but the majority of those named are naturopaths, acupuncturists, and chiropractors—fields which help a great deal of people, but frequently come under fire from traditional medicine for lacking in scientific evidence.



  • Illustration by Alex DeSpain

It's hard to argue with the imprimatur of Harvard University, so terribly upstanding and legitimate. And that's why, for months, this incredibly pernicious claim has continued to haunt our social media feeds and coffee shop banter.

The good news is you don't have to argue with Harvard—just with the people who refuse to correctly interpret what Harvard actually said. Yes, there really was a study that looked at fluoride's effect on children's IQs. But, no, it didn't find a definite link. And—super important—it looked at insanely high concentrations of naturally occurring fluoride outside the United States—concentrations far higher than the amount added to municipal water supplies.

So how did this get twisted around? Cracked.com, of all places, posted a delightful postmortem last summer. An anti-fluoride group wrote up the results and posted them on a part of the Reuters' website that accepts press releases. A lot of people who saw "Reuters"—and reposted the writeup—never read the fine print.

The study also found its way to the Huffington Post. HuffPo can be pretty indiscriminate in whom it lets post on its pages. And in this case, the author was someone named Dr. Joseph Mercola. Mercola, according to Slate, is well known for his controversial views about fluoride. Also cell phones, vaccines, and psychic animals. But Mercola's not merely a rogue doctor with a flair for the conspiratorial. He's also an entrepreneur. With a whole mess of fluoride-free products for sale on his website.

And that's not a conspiracy. That's the truth.