"Oregon is a progressive state--how can they turn their back on something that is so proven and so widely accepted?" says Payne. "If Oregon is such a health-conscious state, why do they shun it?"

"It" is fluoride, a chemical compound that is put in the drinking water of approximately 70 percent of America, and in every big city in the U.S.--except Portland. "It" is a wonder chemical, says Payne, an inexpensive, harmless and efficient way to prevent tooth decay. And "it," says Payne, is something he is determined to introduce to Oregon in the form of Senate Bill 99, which would require all Oregon cities of 10,000 or more to fluoridate their water.

"We have the entire health community behind us," says Senate Minority Leader Kate Brown, who is pushing SB99. The bill should get a hearing within a month's time. Proponents say it has widespread support in the Legislature. Nevertheless, says Brown, a Portland Democrat, "That doesn't mean I think it will be an easy fight."

A lot of the opposition will emanate from Portland and the alternative-medicine crowd. Payne likens the Rose City to "the enemy's backyard."

"It's amazing that fluoridation has opposition at all," says George Riviere, chairman of the Oregon Health Science University School of Dentistry's pediatric department. "Don't say I said these people are crazy!"

West Linn resident Dennis Storey, 80, is typical of those who strongly oppose the bill. "I don't know if they're ignorant or they're bought off or what," he says, but fluoride is "a goddamn biological disaster."

"Welcome to the world of fluoridation," says Kathy Phipps, an OHSU researcher. "There are zealots on both sides."

After decades of toothpaste commercials touting fluoride, it's hard to remember why people ever questioned it. Former Surgeon General C. Everett Koop once called fluoridation "the single most important commitment a community can make to the oral health of its children and to future generations."

Fluoride is a poison--just check out your toothpaste label. In 1997 the Food and Drug Administration required a label aimed at protecting children ages 2 to 6: "Use only a pea-sized amount and supervise child's brushing and rinsing [to minimize swallowing]." It warns parents to keep toothpaste "out of the reach of children under 6 years of age," adding that if the child swallows more than a pea-sized amount, "contact a Poison Control Center immediately."

State Dental Director H. Whitney Payne (center) wants Portland fluoridated whether city residents like it or not. The proposal has Dennis Storey of West Linn (left) asking why a government official would advocate lacing drinking water with toxic waste. OHSU researcher Kathy Phipps (right) strikes a middle ground, saying Oregonians deserve the right to vote on what gets added to their water.

The warning does not mean fluoridation is harmful; many poisons are beneficial in small quantities.

Since 1950, after a number of tests showed that people living in areas with natural fluoride in their water had less tooth decay, public health officials in this country have urged communities to add it to drinking water at the rate of one part per million.

Although the decision to add fluoride to water is not a federal one, the U.S. government has long sought nationwide fluoridation. (Just two years ago it gave the Oregon Health Division an $88,000 grant to promote public acceptance of the idea.) And it is no coincidence that Payne, whose title is Oregon Dental Director, is actually a federal employee.

Payne is a commander in the U.S. Public Health Service, a little-known agency organized along military lines whose medical officers are dispatched to serve the unserved, especially in prisons and rural clinics. Led by the Surgeon General, the PHS has served as fluoridation's shock troops since 1950.

Interestingly, Payne does not have hard data to show that Oregonians' teeth are any worse than those of people in fluoridated states. Although Oregon ranks 45th in the nation in terms of fluoridation (with fluoride in just 24 percent of its public drinking water), Payne concedes that Oregon's oral health is right in the middle of the pack--or as he puts it, the "median."

By some measures, we're doing better than most. For instance, 17.4 percent of Oregonians had lost six or more teeth due to tooth decay or gum disease, versus 19.9 percent nationwide, according to a 1999 study by the Centers for Disease Control.

For Payne, fluoridation is a crusade for social equity. He points to a 1993 study conducted for his agency that found the poor to have more cavities than the rest of the population. Oregonian 5-year-olds enrolled in Head Start averaged 5.67 cavities, compared with 3.4 for the average American 5-year-old.

Whereas oral-health habits may be lacking among the poor, fluoridation "reaches everybody," he says.

Since the state funds dental programs for poor people to the tune of $65 million a year, Payne contends that the state could save millions through fluoridation.

So confident is he in the rightness of his cause that last year, he fired off an email to University of Buffalo Professor Mike Easley, a prominent promoter of fluoridation, predicting, "I will be able to take Portland off the Surgeon General's target list."

Since coming to town, Payne has set up task forces in five cities, including Portland, to mobilize dentists and patients to promote fluoridation. Not only will they build grassroots support for SB99, but they will lobby city councils for local fluoride ordinances if the legislation fails, he says.

 

Lynne Campbell, fluoridation's worst nightmare, isn't talking conspiracy theories, but rather cost-benefit ratios. She says fluoridation may save the state a few bucks by reducing cavities, but could force countless individuals to shell out $650 to $1,200 to repair each stained tooth--the going rate for dental veneers.

In Portland, Payne and the Tri-County Fluoridation Leadership Coalition meet regularly over sandwiches to discuss strategy, says dentist Jim Toothaker of the Portland-based American Association of Public Health Dentistry.

"He's not doing it just because it's in his job description," Toothaker says of Payne. "It's something that he believes in."

Recently, Payne and other health-division officials have been driving to Salem to lobby. They say key committee heads are supportive of the mandatory fluoridation bill, as is Senate President Gene Derfler. Brown says Gov. John Kitzhaber will sign the bill if lawmakers put it on his desk.

But Kitzhaber won't get to use his pen if Lynne Campbell gets her way. She coordinates the opposition from an elegant tree-ringed house that lies at the end of a Lake Oswego cul de sac.

Campbell, a soft-spoken woman with graying dark hair, offers her guests herbal tea, as black and green teas are naturally high in fluoride. In her home office, the sound of wind chimes drifts in from outside, while a fax machine and computer lie dormant. The bookcase holds tomes on advertising, cooking and money smarts, as well as hard-core guides to insider politics like Hedrick Smith's The Power Game.

Campbell, unmarried, was until recently a successful ad buyer, determining target audiences for her clients and how best to reach them, then negotiating the deals. Today, however, she is the volunteer head of Oregon Citizens for Safe Drinking Water.

In the '50s and '60s, extreme conservatives considered fluoridation a communist plot. Campbell's views bear little resemblance to theirs; her opposition is based on science and individual rights.

"I think people should have a right to choose their medication--particularly since we're not talking about a life-threatening disease, we're talking about cavities," she says.

Campbell, 50, hopes to build on Oregonians' long distrust of fluoridation. Portland has voted down the idea four times since 1956, three times on the ballot and once by a vote of the city water-quality committee in 1994. Eugene residents voted it down in 1977, and in the past three years both Willamina and Lake Oswego have said no.

Campbell's interest was piqued in 1998, when fluoridation was before the Lake Oswego council. Campbell remembered her father and grandfather, both Harvard-educated engineers, saying that dosing water with a poison like fluoride, even in small amounts, was insane.

Now she spends her days doing research on the web, networking with other anti-fluoridationists around Oregon, contacting chiropractic and environmental groups as well as other potential allies.

Over the last month, she's made the 45-mile drive to Salem four times to meet with more than a dozen senators. There, Campbell is a powerful proponent, according to Richard Burke, an aide to Sen. Gary George (R-Newberg). "She came off to me as someone who is very reasonable and very confident about her issue," he said. "She seemed very well composed; her demeanor was professional... She seemed like she had legitimate arguments."

Talking to lawmakers, Campbell knows she has to escape the stereotyping of her movement as a bunch of kooks. As an anti-fluoridationist, "It's very easy to be dismissed," she says. "I've worked in advertising for 21 years: I understand the power of PR."

She is aware that some of her allies make alarmist-sounding claims about how fluoride causes everything from cancer to Down syndrome and Alzheimer's to attention-deficit disorder. For each study they brandish as proof, the fluoridationists counter with several that say fluoride is hunky-dory.

So Campbell takes a different tack. She says the cost-benefit equation on fluoridation has changed a lot since the oral-health crisis of the 1940s. During World War II, the country was rejecting so many military recruits due to dismal oral health that fluoridation was considered a matter of national defense.

Since then, the downside to fluoridation has increased. As proof, Campbell points to one consequence of fluoride on which all experts agree, called dental fluorosis. Too much fluoride causes mottling and white blotches on teeth. The mild cases are mostly undetectable, but the non-mild ones can be unsightly.

Rates of fluorosis, once negligible, have been rising around the country. Nationwide, dental fluorosis estimates range from 29 percent on up; one study found 80 percent of residents examined in Atlanta, Ga., had the condition.

The cause of the rise in fluorosis is simple: Fluoride is a staple of modern industrial society, and we are increasingly exposed to it even if our water isn't fluoridated.

Countless tons of fluoride-bearing ore are mined for smelting and fertilizer plants. They emit fluoride in air pollution and as liquid industrial waste. The liquid waste, particularly from phosphate fertilizer factories, is used in water flouridation, while purified fluoride is used to make everything from computer chips to nuclear bombs; it's also been an ingredient in nerve gas, chemotherapy drugs, Prozac and the "date-rape drug" called Rohypnol.

Over the past 30 years, fluoride has increasingly turned up in everything from fruit juice to breakfast cereal to baby food. One cup of black or green tea contains as much fluoride as seven liters of fluoridated water.

Government reports say fluoride is most toxic to people with kidney problems and calcium-deficient diets, the latter of which Campbell points out are typical of the poor and most kids.

She argues that even if you believe fluoride fights cavities, delivering a recommended dose through the water supply is about as scientific as dropping antibiotics from helicopters. "Some people drink very little water, while others drink a lot, among them people with diabetes," she says.

Walter Gabler, the former head of OHSU's biochemistry department, used to fight for fluoridation. But now the former dentist says the risks outweigh the rewards.

She points to professors from Cornell, Dartmouth and the former head of the neurotoxicology department of Harvard's Forsyth Dental Center, who all claim fluoride's hazards are real.

Also, the union local that represents scientists in the Environmental Protection Agency's Washington, D.C., headquarters opposes fluoridation, claiming fluoride is a carcinogen and worse.

The EPA local's president, Bill Hirzy, a chemist in the EPA's Office of Toxic Substances, contends that fluoridation continues to be government policy only because of "institutional inertia [and] embarrassment among government agencies that have been promoting this stuff as safe."

(In response, Payne notes that Hirzy's local does not speak for the EPA. He argues that if fluoridation were dangerous, the EPA would not allow it.)

As for fluoridation's benefits, Campbell points out that most European countries have rejected fluoridation as unnecessary or unsafe--and their cavity rates have gone down as much as Americans'.

Aside from her lobbying, Campbell has launched a counterattack: SB744, introduced by George. Called the Fluoride Product Quality Control Act, it would require any fluoridation chemical to be proven effective by the Food and Drug Administration (fluoride never has been), and make it illegal to add anything to the water that is a pesticide or a hazardous waste.

Campbell's bill seems to have far less of a chance than SB99. That bill has been assigned to the Health and Human Services Committee chaired by Sen. Bill Fisher (R-Roseburg). Fisher has not taken a position, but SB99 proponents say he likes the idea.

Besides the powerful advocacy of Brown, the bill's supporters say they have a receptive ear in House Health and Public Advocacy Committee chairman Bill Kruse
(R-Roseburg), as well as Ways and Means chairman Lenn Hannon
(R-Ashland).

As for Senate President Derfler, he says he is not impressed by what he calls the "scare tactics" of the anti-fluoridationists.

Unlike some battles in Salem, where the main motivation for many groups is their profit margin, the combatants dueling over this bill each have the public's good at heart.

With fluoride's benefits in mind, the dental and public-health establishments want conclusive proof of harm before dropping their push to fluoridate the nation, while their foes want conclusive proof of safety.

The gap is philosophical, which is why it has long seemed impossible to bridge. Now, however, even that is starting to change.

That's because it's possible to be pro-fluoride but anti-fluoridation.

Walter Gabler, former chairman of the biochemistry and cell biology department at OHSU, says fluoridation was a good idea through the '70s, but toothpaste is doing the job just fine now. As for SB99, he says, "I probably wouldn't be in favor of it--and that's going to shock some people, but that's too bad."

It is also possible to be pro-fluoridation but against SB99.

OHSU scientist Phipps, the researcher who conducted the 1993 oral-health survey that Payne cites to justify SB99, remains pro-fluoridation but thinks communities should have a right to vote on it.

In part that's because it's the Oregon way, she says, but it's also because there are "some communities that need fluoridation, and some communities that don't need fluoridation--though Whitney would probably kill me for saying that."

---

SHIFTING SCIENCE
Proponents of fluoridation argue that thousands of studies since 1950 have put questions about the safety of water fluoridation to rest. But if anything, the questions keep growing.

In the last six months, the British and Canadian governments both released wide-ranging reports that reviewed the thousands of published scientific studies on water fluoridation.

The British review was the most comprehensive ever done of fluoride science. The Canadian review, which looked at a different set of studies, reached the same conclusions as the British. Both directly challenged the conventional wisdom on fluoride in the United States.

EFFECTIVENESS: H. Whitney Payne, Oregon's dental director, says fluoridation cuts cavities by up to 35 percent in adults and 65 percent in children. The Canadian and British studies, however, found that fluoride does appear to cut cavities, but only by about 15 percent.

EQUITY: Proponents of fluoridation claim that it will decrease the gap in oral health between rich and poor. The Canadian study was silent on this claim; the British study found no evidence to support it.

SAFETY: Payne and the U.S. dental establishment contend that science has definitively proven fluoride to be safe. The British study, however, "did not show water fluoridation to be safe [because existing fluoride] research was too poor," summarized Dr. Trevor Sheldon, head of the National Health Service unit that conducted the study, in a letter to Parliament. "Until high quality studies are undertaken...there will continue to be legitimate scientific controversy."

DENTAL FLUOROSIS: Payne and the U.S. dental establishment dismiss dental fluorosis, or tooth mottling, as merely a cosmetic effect, but both the British and Canadian studies said it should be taken more seriously.

Both the British and Canadian studies found that fluoridation significantly increased fluorosis rates. At the U.S. government's recommended level of fluoridation, 12 percent of the population will have unsightly fluorosis, the British study said.

David Locker, a dentist who is the director of the Community Dental Health Services Research Unit at the University of Toronto, conducted the Canadian study. He says fluoridation was a good idea when first introduced, but the new evidence on risks and benefits means that communities should think twice before approving it today.

"A lot of the research on the benefits of fluoride was extremely poor--on that the British study and I agree," he said.

Payne, for his part, is not deterred by the studies, calling them "a useful springboard for further review."

News that the scientific landscape on fluoride had changed went unnoticed in the United States until last Thursday, Feb. 15, when ABC News commentator and medical author Nicholas Regush took to the airwaves to decry "fanaticism and junk science" in the realm of fluoridation--thereby propelling anti-fluoridationists into the mainstream.

"What is amazing," he said, "is that public health policy in this country has allowed water fluoridation to continue in the absence of solid scientific evidence that its benefit is greater than its risk."

--NB