Endorsing a popular public health measure shadowed by lingering controversy, Gov. Pete Wilson on Monday signed into law a bill requiring most California communities to add fluoride to drinking water.
The new law, which takes effect Jan. 1, applies to water districts serving more than 10,000 households. It brings California in line with many other states that embraced fluoridation after studies revealed its power to reduce tooth decay--particularly among low-income children who do not receive regular dental care.
"Fluoridation of drinking water is recognized as a safe, effective method of reducing tooth decay on a community scale," Wilson said. Adding fluoride to the public water supply will dramatically reduce dental costs for individuals and taxpayers who finance the state Denti-Cal program, the governor said.
California dentists--many of whom were gathered at a convention in Las Vegas Monday--applauded Wilson's action, predicting that fluoridation could ultimately reduce tooth decay by up to 40%.
"Finally, California can take its place with other states and enjoy this great benefit," said dentist Eugene Casagrande, founder of Los Angeles Citizens for Better Dental Health. "California is usually a leader. With fluoridation, we're just catching up with the rest of the nation."
Michael Miller, president of the California Dental Assn., noted that the price of fluoridation will amount to about $40 per person over a lifetime.
"We definitely believe it's worth the investment," said Miller, a dentist in San Bernardino.
Opponents, however, were highly critical of the governor, accusing him and the Legislature of foisting fluoride on a defenseless population of water drinkers.
Some foes view fluoridation as a form of "compulsory mass medication." Others say studies suggest a link between fluoride and an increased incidence of certain cancers and hip fractures.
Californians have rejected fluoridation in local elections "over and over and over again," said David Kennedy, a San Diego dentist who led the charge against the new law. "But the fools in Sacramento just don't listen. They're going to shove it down our throats."
Kennedy said he won't sit idly by and wait for fluoride to show up in his water pipes. He recently bought a distiller for his home and will use it to remove the substance from his water.
Fluoridation involves increasing the amount of fluoride already present in water to a level considered optimal for preventing tooth decay. The process was pioneered 50 years ago in Grand Rapids, Mich., but stubborn opposition has perpetuated anxieties about its safety, slowing its spread.
At one point, the John Birch Society claimed fluoridation was part of a Communist plot to poison America. Others suggested it was a government conspiracy aimed at turning people into "a race of moronic, atheistic slaves."
Today, only 17% of Californians receive fluoride in their drinking water, compared to 62% of the population nationwide. California ranks 47th among states in terms of the proportion of its residents receiving fluoride through the faucet. Most of California's large cities--including Los Angeles, San Diego, Sacramento and San Jose--do not fluoridate.
The controversial bill was authored by Assemblywoman Jackie Speier (D-Burlingame), who became a champion of fluoridation after a pediatrician advised her to give her son fluoride drops.
Speier calls fluoridation "the most cost-effective public health measure available" in the United States and said it will save taxpayers hundreds of millions of dollars annually in Denti-Cal costs. Two-thirds of the state's annual $650-million Denti-Cal program is spent on restorative dentistry that can largely be avoided through water fluoridation, Speier said.
Despite opponents' misgivings, fluoridation has been endorsed by a Who's Who of the medical establishment. In 1991, the U.S. Public Health Service reviewed research on fluoridation and found no credible evidence of health risks.
Among its most ardent supporters is former Surgeon General C. Everett Koop, who argues that fluoridation is especially important for poor families who are deprived of routine dental care. Unlike many public health measures, fluoridation requires no conscious effort by the people, Koop and others point out. They need only drink tap water to benefit.
Initially, Speier's bill required water districts to fluoridate water supplies immediately. But when opposition surfaced from California's water agencies--who face a cumulative total of $35 million in capital costs to comply with the law--Speier amended her legislation.
Now, districts must fluoridate only when money for the necessary equipment becomes available--most likely from foundation grants. Operating expenses, estimated at $5 million annually for all of California, will be covered by the state.
The new law comes at a time when the city of Los Angeles is moving toward fluoridation on its own. Recently, Councilwoman Ruth Galanter asked the Department of Water and Power to study the costs, search for funding sources and report back this fall.
Estimates suggest that it would cost Los Angeles $3.5 million to install fluoridation equipment, and $750,000 more annually to run and maintain the system.