This month, voters will decide whether to approve a plan to fluoridate Portland's water. Supporters say Portland children - especially in low-income families - suffer aggravated dental problems because the city has chosen not to add fluoride. Opponents say water fluoridation is the wrong way to address a public health problem. And so a battle that has played out before at the state level is now going on in Portland. From Oregon Public Broadcasting, April Baer reports.
For all the discussion over the city's $5 million plan to add fluoride to water, many voters may be unaware that Portland already adds several substances to its water supply.
If the fluoridation measure passes, its apparatus would be added to the Water Bureau's existing infrastructure, out at Lusted Hill. Andrew Degner manages the facility for the Bureau.
Degner: "What you're looking at here is our ammonium feed room. We have two, ten-thousand gallon tanks of 19.3% aqueous ammonia. We use this pump system to feed it into the process."
The tanks are each the size of a small bedroom, They loom over a wall of piping and valves that makes monitoring possible.
Chlorine is added at the Bureau's headworks at Bull Run as a disinfectant. Then, at Lusted Hill, ammonia is added to help bind the chlorine within the treated water, to keep it from breaking down, so that it doesn't dissipate too quickly.
Sodium hydroxide enters the mix next, to adjust the water's pH.
Degner: "It's 50% strength. We feed it at a dosage rate of 3 to 5 parts per million, which is much more than the amount of ammonia we feed, but it takes that much to raise the pH to 8.0. The reason we add the sodium hydroxide is to reduce lead and copper corrosion control in the system."
Degner sits down in a cavernous room lined with lockers, shelving bearing all kinds of pipes and parts, also a couple of exercise machines. This room is also used as a bike locker for the cycles technicians ride to other sites to get samples.
Degner says he's been involved in systems elsewhere that handled fluoride, and other systems that have transitioned in new additives.
He says if the voters approve Measure 26-151, to fluoridate Portland's water, adding a fluoridation system would be relatively straightforward, expanding the size of the Lusted Hill facility by about a third.
But fluoridation opponents have been working to convince voters to vote no. Clean Water Portland, the opposition campaign to Measure 26-151, says fluoridation chemicals do not belong in Portland water.
One of the opposition's activists is Jay Levy.
Levy: "I'm a general dentist, I practice over here on Southwest 10th."
Levy met with me back when the opposition campaign was still trying to get on the ballot, before the city scheduled a referendum. He felt so strongly about the issue, he was taking breaks from his practice several times a week to gather signatures and talk to people as they stopped at the downtown food carts for lunch.
Levy: "Are you a registered voter in Portland?….you vote for Mayor…
Potential Voter: "I'm not happy about it. But you probably are, because you're a dentist."
Levy: "I'm not happy about it, I don't think it belongs in the water supply."
Levy's background is in dental neurophysiology.
Levy: "First off, this is about public process. The public deserves the right to decide, and to review the evidence for themselves."
Levy explained to anyone who asked during his canvassing that he feels water fluoridation sidesteps the real issues in dental health.
Levy: "I think the evidence is pretty clear that topical fluoride application is an OK thing to do. The most important message I give my patients is that we need to eat whole foods, eat three meals a day, nothing between meals but plain water… whole foods are in your lunch, I'm happy to see that…. we need fasting periods to wash residues away. I give this message to all my patients and it works!"
Levy says he knows it's not easy, but he feels strongly it's incumbent upon everyone - dentists and laypeople alike - to learn how to read the scientific literature and evaluate for themselves.
Levy says he thinks this is true for all communities, especially those that have traditionally suffered major dental problems.
Levy: "I've worked in public health settings. I've changed the diet of poor people in public health settings. I couldn't reach everybody. When you're working in a clinic you have time constraints. The offices aren't really structured around preventative efforts and nutritional counseling."
Other health providers who work with kids that don't have good dental care take a different view.
Stafford: "Got your sunglasses son ready to go? Lean back we'll take a peek."
This Kaiser Permanente clinic in East Portland, Dr. Greg Stafford is working with a ten-year-old boy. At age 7, this boy had to be taken to a hospital, put under general anesthetic, and had ten decayed teeth removed.
"You're doing beautifully, thank you!"
Stafford's colleague, Dr. James Smith, grew up in the north end of Portland, and went to Jefferson High School. After getting his dental degree and spending a few decades in the Navy, he came back home. He observed that the quality of dental health hadn't improved.
Smith: "Obviously the toothaches but the rampant carries, young kids who have to be taken to the hospital at a young age, that's very concerning."
Smith supports the fluoridation campaign. Other health care professionals who support the measure point out there are health risks and costs associated with putting children so young under anesthesia for dental procedures.
The cases Smith and Stafford see, they say, are bad enough. But Smith really worries about children who don't have insurance, and who never come in.
Dental decay is preventable. It's not rocket science, it's not something new. It shouldn't happen.
Back at the Portland Water Bureau, manager Andrew Degner stresses the Bureau does not take a stance on the ballot measure.
If the voters decide in favor of fluoridation, he will oversee construction of the system. If the voters reject fluoride, he'll do nothing.
Copyright 2013 Northwest Public Radio