Spokane expects findings of fluoridation study in June

After years of debate, a report is expected in June that will summarize the feasibility and costs of adding fluoride to the city of Spokane’s water supply.

Supporters of fluoridation say the study will help inform voters, city residents and local leaders before they decide whether to commit to the costly infrastructure investment. Opponents worry completion of the study will be a formality.

Fluoridation is the process of artificially adding a fluoride compound into a municipality’s water supply, a public health intervention that has been widely used for nearly 80 years in the United States to reduce the rate and severity of cavities, particularly in populations with otherwise poor dental health access.

Fluoridation has become increasingly controversial in recent years, largely due to toxicity concerns that have been largely dismissed by the scientific and medical communities.

Spokane is the largest city in Washington that does not artificially fluoridate its water. In 2022, the City Council voted 5-2 to accept a $4 million grant from the Arcora Foundation, $600,000 of which was slated to study the feasibility and long-term costs of adding fluoride to the city’s water.

The remainder of the grant, which included $3 million from Arcora along with $1 million raised by Better Health Together, would be spent on design of fluoridation implementation if the city chooses to move forward. In early March, the City Council voted to use up to $360,000 in state grants to supplant Arcora funds during the remainder of the study; Arcora funds not used during the feasibility study can be used during design.

Fluoridation supporters and opponents agree that adding the mineral to Spokane’s water supply would not be simple.

Though many cities treat their water at a single source, Spokane has seven separate wells and an eighth coming soon. That means each well would have to be outfitted with the equipment to add fluoride, a likely expensive proposal.

The vote last year to commence the study, two years in the making, followed a protracted fight with Mayor Nadine Woodward, who never weighed in on the scientific merits of the dental intervention but argued that voters should be able to decide. The City Council passed a resolution the same day that promised to solicit public feedback after the study was finished, though it stopped short of pledging to put the matter to an advisory vote.

Notably, Spokane voters have shot down fluoridation three times before, most recently by a narrow margin in 2000.

Fluoridation is mainstream in the U.S. But while the CDC estimates that a vast majority of the American population drinks fluoridated water, the process frequently sparks public opposition in cities that seek to implement it, including Spokane.

Some opponents to fluoridation have argued that the government should not force a medical intervention on residents, particularly one that poor residents would be unable to circumvent.

If fluoridation is implemented, Councilman Michael Cathcart has previously said he may personally invest in a reverse osmosis system to remove fluoride from his drinking water. But he noted many people in his district would not have the resources to do the same.

Other opponents, such as Safe Water Spokane, a group formed in 2020 to resist fluoridation, have argued that fluoridation is not only a waste of taxpayer money but actively dangerous to residents.

“Ninety-nine percent of the water isn’t even ingested, but literally goes down the drain through toilets, showers, car washes and other uses,” Jeff Irish, the group’s chair, said in a statement in 2020.

Notably, the studies cited by Safe Water Spokane themselves contradict the confidence of the group’s rhetoric, showing tenuous links between high exposure to fluoride and health defects while calling for better research.

“Those are people that don’t have much knowledge on the subject,” said Torney Smith, former Spokane Regional Health District administrator, of people concerned about supposed risks of fluoride. “They’ve been sold a bill of goods.”

Smith said that the fluoridation controversy and lack of political will to start adding fluoride to municipal water was a significant source of frustration for him in the decades he led the regional health district.

While implementation would likely be expensive, the costs would be outweighed by the communitywide cost savings from improved dental health, he argued.

“This has been studied and been widely used in the United States for more than 70 years, with millions of people in major cities,” he added. “It does not cause health issues.”

The concerns are not entirely without legitimate scientific debate. Some studies, particularly out of China, have suggested there could be a link between high doses of fluoride and cognitive impairment, although the associated dosage was well in excess of what U.S. regulators recommend. Most other studies contradict those findings, according to a 2022 systemic review of the academic literature.

There are some well-documented symptoms caused by high doses of fluoride, such as dental fluorosis, which can stain teeth, and skeletal fluorosis, which can cause bones to become more brittle. Dental and skeletal fluorosis, however, are exceedingly rare in communities where there is less than 2 or 4 parts per million of fluoride, respectively, according to the CDC.

The recommended level for artificial fluoridation in the United States is 0.7 parts per million, according to the CDC.

Smith noted that fluoridation has been implemented in every large city on the West Side , as well as the city of Cheney and Fairchild Air Force Base. All U.S. military bases serving more than 3,300 personnel have been required to fluoridate their water since 2016.

Cheney has been fluoridating its water since the late 1960s, said Todd Ableman, Cheney’s director of public works. That community only has to add a bit of fluoride, and for some wells none is added, because the compound is found naturally in its waterways.