For more than a decade, politicians, environmentalists and dentists have fiercely debated the city of Sacramento's practice of placing fluoride in the drinking water.
It was a talking point during the mayoral election of 2000. A short-lived campaign was once launched to force a public vote on the practice. And it seems every time fluoride is merely mentioned at a City Council meeting, opponents and supporters line up to have their say.
And so it was with some touchy deliberation that the City Council voted last week to extend its fluoridation program, despite a report from utilities officials that continuing the practice will cost millions of dollars in water revenue collected from city residents and businesses.
According to a study by the city's Department of Utilities, annual operation and maintenance costs for the city's fluoridation program have nearly tripled, from $350,000 when it started 12 years ago to nearly $1 million in recent years.
What's more, a city study last year found the system's infrastructure in need of immediate upgrades, to the tune of up to $3.7 million. Over the next 20 years, the city estimates it will cost between $43 million and $48 million to operate and maintain the fluoridation system and replace needed equipment.
"The existing equipment is at or near the end of its useful life, and there's going to need to be some significant investment," city utilities engineer Brett Ewart told the City Council on Tuesday.
Fluoride advocates and some council members argued that the cost of the program is far outweighed by the public health benefits of fluoridation – especially for low-income neighborhoods where dental care is lacking.
Dentists told the council that fluoride reduces tooth decay by up to 40 percent. And as state budget cuts have slashed dental care to families in need, fluoridation is more vital than ever, they argued.
"With our children at such a high risk due to a lack of dental access, now is not the time to abandon the near-universal protection that fluoride provides all our residents," said Terrence Jones, a dentist and a member of the First 5 Sacramento Commission. "It is safe, it is cost-effective and it benefits people of all ages, regardless of education or race."
The council vote to continue fluoridation was not unanimous. Council members Rob Fong and Darrell Fong both voted against the measure, with Rob Fong saying he is "philosophically opposed to the imposition of fluoride on all of our citizenry."
"No matter what neighborhood you live in or how much money you make, I think just about everyone goes to the store and buys things like milk and toothpaste and toothbrushes," he said. "And frankly, I think oral hygiene is part of the health decisions we make for ourselves and our families."
While the First 5 Sacramento Commission has provided the city with a $550,000 grant to help with the costs of fluoridation, that's just a small percentage of what the city needs. In exchange for accepting the grant, the city agreed to continue fluoridation until at least June 30, 2015.
If the city stops fluoridation before that date, it would have to repay the grant, with interest. Between operational costs and system upgrades, the city expects to spend between $5.6 million and $7 million between now and the end of the First 5 grant funding period – meaning that the grant will provide less than 10 percent of the system costs over the next three years.
The rest of the money will come from city residents and businesses through their water bills. City officials said there are no plans at this time to raise water rates to cover the rising costs associated with fluoridation.
"The question is, how does the city of Sacramento continue to provide that service in tough economic times?" asked Councilwoman Angelique Ashby, who supported the fluoride program's extension. "We're probably going to need more help."
First 5 officials said they would explore providing more funding to the city in the future. But first, they want to see that their grant dollars – which will help pay for some of the system upgrades – lead to cost savings in the system's operation.
"We want to do whatever we can with the city to continue to fluoridate," said Debra Payne, the dental program planner for First 5.
Environmentalists continue to criticize the practice, which they argue forces a drug on the public and leads to chemicals entering rivers and creeks.
Kim Glazzard, of Organic Sacramento, told the City Council there are "so many misconceptions of the benefits and risks of fluoride injection." And she criticized the council for making a long-term commitment to fluoridation during a harsh financial climate.
"This is a financial burden on the ratepayers, and it is not prudent to be obligating Sacramento to this three-year contract (with First 5) when the city's finances are already in shambles," she said.