At 4 p.m. on Monday, the city of Aberdeen public works department disconnected the mechanism that added fluoride for the better part of 27 years to a water system that services almost 20,000 residents in Aberdeen, Cosmopolis and adjacent areas within Grays Harbor County.

The city will realize a cost savings of just under $20,000 annually.

The decision comes after an arduous year-long process and an 8-3 vote by the Aberdeen City Council, and Ward 6 Position 11 Councilmember David Lawrence says he believes removing fluoride from the city’s water supply was the right decision.

“I feel relieved, actually. It was a big process, more than I thought it was going to be,” Lawrence said. “There’s a lot of municipalities around the nation that are going away from fluoride, they’re dropping it, I think we’re in the right move.”

How Aberdeen arrived at its decision

The fluoridation of municipal water systems has become a hot-button topic in recent years, although the debate over the naturally occurring mineral has cropped up periodically since Grand Rapids, Mich., became the first American city to add fluoride to its drinking water in 1945.

Competing studies, competing experts, public opinion and conspiracy theories have led to many questioning the efficacy and benefits of adding fluoride to public drinking water.

The quest to decide the fate of the fluoridation of Aberdeen’s water began after the city of Montesano broached the topic in January 2023. Thirteen months later in February 2024, the Aberdeen City Council voted to authorize research into the impacts of fluoridation and what would happen if it were to be removed from the city’s water supply, after Lawrence raised the issue.

“I investigated it quite a bit over the years and I found it’s detrimental to your health, cognitive values, it affects them,” Lawrence said after Wednesday evening’s City Council meeting. “If it doesn’t work out we can always put it back in. I just think there’s too many harmful outcomes that can happen from it. It needs to go away. I don’t think the city is responsible for medicating the population.”

In April 2024, the Aberdeen City Council invited Shelley Guinn, the state oral health program manager for the Washington State Department of Health, to speak about what fluoride does, its effect on teeth and the rest of the human body.

“Number one, fluoride occurs naturally in all water,” Guinn said at the time. “Number two, fluoridation is the adjustment of the fluoride level. This can be up or down to just the right amount to prevent dental decay and benefit health.

“Tooth decay is the most common, chronic disease on the planet. It starts out as the most common, chronic disease of childhood. It’s extremely costly to treat and it can be prevented.”

Although fluoride is added to most toothpastes on the market, Guinn argued that fluoridated drinking water provided beneficial effects long after toothpaste swirls down the drain.

“The fluoride in our toothpaste provides a temporary, higher dose of fluoride that just stays in the mouth until you spit it out,” Guinn said. “Whereas when we drink water with fluoride, it does get into our saliva. It does get into our salivary glands, and so that way it does help to continually be in our teeth. And we’re drinking water more often than we’re brushing our teeth.”

Bottled water on the other hand may or may not contain added fluoride, but since many are filled from municipal sources, fluoride may be in your bottled water of choice. In 2022, the U.S. Food and Drug Administration issued its “final rule” on fluoride in bottled water.

“The Food and Drug Administration is revising the quality standard for bottled water to specify that bottled water to which fluoride is added by the manufacturer may not contain fluoride in excess of 0.7 milligrams per liter (mg/L), which available data suggests provides an optimal balance between the prevention of dental caries and the risk of dental fluorosis. This final rule revises the current allowable levels, which range from 0.8 to 1.7 mg/L, for fluoride in domestically packaged and imported bottled water to which fluoride is added.”

That “final rule” was issued seven years after the U.S. Public Health Service Commissioned Corps (USPHS) revised guidance on fluoride content for public water systems. The U.S. Centers for Disease Control and Prevention’s website (cdc.gov), features a Timeline for Community Water Fluoridation. The 2015 entry states:

“Based on the widespread availability of fluoride in drinking water and oral care products, along with considerations of dental fluorosis trends and evidence on fluid intake in diverse climates, the USPHS simplifies recommendations for optimal fluoride concentration. The new guidance advises community water systems to adopt a uniform concentration of 0.7 mg/L of fluoride in drinking water, ensuring cavity prevention benefits while minimizing the risk of dental fluorosis. Consequently, public water systems nationwide commence fluoridation at the recommended 0.7 ppm level.”

However, the widespread proliferation of fluoride beyond drinking water has become one of the linchpins for the arguments against adding it to municipal water supplies. The counter to that argument is the cost and accessibility of dental care.

At a September 2024 Aberdeen City Council meeting, Mike McNickle, director of Grays Harbor County Public Health, spoke about the government’s role in prevention, especially when it comes to residents who cannot afford dental care.

“Fluoridation helps level the playing field, assuring all community members — regardless of socioeconomic status, have protection against tooth decay,” McNickle said. “In 2022, data shows that 50.9% of children under 6 who live in Grays Harbor County and are enrolled in Medicaid, are also not receiving dental care. Overall, in 2022, only 31.4% of all children enrolled in Apple health received one or more dental treatments. That means 69% did not.”

The debate has intensified in the past 15 years with books, articles and papers written and published throughout the collective international medical and dental communities.

In 2010, Drs. Paul Connett Ph.D, James Beck MD, Ph.D, and H. Spedding Micklem went so far as to write a book titled The Case against Fluoride: How Hazardous Waste Ended Up in Our Drinking Water and the Bad Science and Powerful Politics That Keep It There.

In their book published by Chelsea Green Publishing, the authors argue that “just because the dental and medical establishments endorse a public health measure doesn’t mean it’s safe. In the case of water fluoridation, the chemicals that go into the drinking water that more than 180 million people drink each day are not even pharmaceutical grade, but rather a hazardous waste product of the phosphate fertilizer industry.”

That characterization may sound extreme, but two elements have emerged regarding the fluoridation of public drinking water — safe levels and method of ingestion. Although the recommended amount of added fluoride has been reduced, there is some discussion that swallowing fluoride can be harmful, especially for pregnant women and their unborn babies, and young children.

Jill Pease, Communications Director, College of Public Health and Health Professions at the University of Florida wrote an article in May 2024 that stated a study led by University of Florida College of Public Health and Health Professions researcher Ashley Malin, Ph.D, found that “higher fluoride levels in pregnant women are linked to increased odds of their children exhibiting neurobehavioral problems at age 3.”

According to the CDC, “In 2022, more than 209 million people, or 72.3% of the U.S. population served by public water supplies, had access to water with fluoride levels that prevent tooth decay.”

However, in September 2024, in a case involving the Environmental Protection Agency, federal Judge Edward Chen ruled, “… there is substantial and scientifically credible evidence establishing that fluoride poses a risk to human health; it is associated with a reduction in the IQ of children and is hazardous at dosages that are far too close to fluoride levels in the drinking water of the United States.”

Meanwhile, the U.S. Department of Health and Human Services’ National Toxicology Program (NTP) “conducted a systematic review of the published scientific literature on the association between fluoride exposure and neurodevelopment and cognition,” and published a “monograph” of their findings.

The NTP “concluded, with moderate confidence, that higher levels of fluoride exposure, such as drinking water containing more than 1.5 milligrams of fluoride per liter, are associated with lower IQ in children. The NTP review was designed to evaluate total fluoride exposure from all sources and was not designed to evaluate the health effects of fluoridated drinking water alone. It is important to note that there were insufficient data to determine if the low fluoride level of 0.7 mg/L currently recommended for U.S. community water supplies has a negative effect on children’s IQ. The NTP found no evidence that fluoride exposure had adverse effects on adult cognition.”

Upon peer review by the National Academies of Sciences, Engineering, and Medicine, their 2020 report “identified deficiencies in the analysis of various aspects of some of the studies and in the analysis, summary, and presentation of the data in the draft monograph, provided many suggestions for improvement, and concluded that NTP had not adequately supported its conclusions.”

According to the American Academy of Pediatrics, “Consequently, NTP removed the classification of fluoride as a ‘hazard.’ Going one step further, the National Academies instructed NTP to clarify several important points. For example, the studies it reviewed do not address or raise safety concerns about low fluoride exposures, ‘including those typically associated with drinking-water fluoridation.’ The revised draft also presented an opportunity to include research, some contradictory, published through November 2021.”

Aberdeen deliberations

At the Dec. 11, 2024, Aberdeen City Council meeting, former fluoridation advocate turned skeptic Dr. Bill Osmunson made a presentation arguing against the fluoridation of municipal water supplies using NTP monograph data to back up his arguments. In a paper presented to the NTP, Osmunson described himself as “a clinical dentist who treats cosmetic and functional dental fluorosis. For about 25 years I promoted fluoride ingestion and when I read the research for myself, I stopped promoting fluoride ingestion due to over exposure and lack of evidence of efficacy, safety, dosage, FDA CDER NDA (Center for Drug Evaluation and Research new drug application), label, prescribing doctor, or freedom of choice.”

“Since the (2020 NTP report), there were 12 more human studies, 12 of 12 high quality, showing lower IQ,” Osmunson told the Council. “The city of Aberdeen is scientifically, and legally and ethically correct. I think the council needs to consider that just because you say ‘no’ to fluoridation, does not mean you’ve solved the problem of rampant decay. It is a problem, I had to treat it, I took kids to the hospital. It’s grim.”

Osmunson went on to present recommendations for “safe” fluoride applications.

At the end of Osmunson’s presentation, Ward 3 Position 5 Councilmember Liz Ellis commended Osmunson’s singular focus, but questioned his sources.

“The diligence and persistence of your endeavors is to be commended, but I disagree with your science and I stand with our local dentists and department of health recommendations,” Ellis said.

During the discussion before the vote, Ward 4 Position 7 Councilmember Stan Sidor, who tried to abstain from the vote, indicated that he found the information presented before the City Council over the course of the process incomprehensible.

“When this was first brought up, I voted against this proposed ordinance, and we’ve heard a lot of input, and Dr. Osmunson provided a lot of fancy studies and graphs and things, but this is beyond me, I have no idea,” Sidor said. “I do know the citizens of my ward, the majority of them did not want fluoride removed. It wasn’t a strong majority. I sincerely have no clue or idea if it’s a good thing or not.”

Ward 4 Position 8 Councilmember Deb Hodgkin argued that plenty of fluoride sources exist beyond city water, but also mentioned she’d like to make sure children had adequate access to dental products.

“I feel confident there are various ways of getting fluoride, for those who are fearful of having fluoride in their water or fearful it’s causing problems with IQ or learning disabilities, they can avoid it, there are other ways of getting it, I feel confident no one will go without fluoride,” Hodgkin said. “I would love to see the health department do a program in the schools where they hand out toothpaste, but I think most children have access to toothpaste, hopefully, if not, that would be a wonderful thing to see the health department participate in.”

In a survey of Aberdeen residents, of the 298 respondents, 53% voted to keep fluoride in the city’s water.

The City Council proceeded to vote on the removal of fluoride at the Dec. 11 meeting.

To add more to the discourse, Seattle’s NPR news station KUOW Puget Sound Radio published a story by Pien Huang Thursday, that indicates the NTP continues to assert that “higher levels of fluoride exposure, such as drinking water containing more than 1.5 milligrams of fluoride per liter, are associated with lower IQ in children.” The findings published in the Journal of the American Medical Association — Pediatrics on Monday also state, “There were limited data and uncertainty in the dose-response association between fluoride exposure and children’s IQ when fluoride exposure was estimated by drinking water alone at concentrations less than 1.5 mg/L. These findings may inform future comprehensive public health risk-benefit assessments of fluoride exposures.”

Several sources quoted in Huang’s article refute or temper the NTP’s findings.

See? Clear as mud.

Much of what you find when you dive down the fluoride rabbit hole(s) on the internet reads like a chemistry textbook. You can spend hours reading about parts per million and high and low levels of fluoride and the positive and negative effects of both. You can read books, scientific papers and journal articles and watch videos, and listen to podcasts. After all of that, you’ll still find yourself in a gray area with a splitting headache.

The bottom line when it comes to Aberdeen and fluoride is after much discussion, debate, public discourse and expert presentations, “The [Aberdeen] City Council finds they have sufficient concerns regarding fluoride in the public water system and finds it is in the best interest of the city to discontinue fluoridation of its public water system.”

And they did just that by repealing Ordinance No. 6191 and Aberdeen Municipal Code Section 13.56.515 titled “Addition of fluoride — Administration,” which were adopted in 1998, and discontinuing the fluoridation of the city’s water supply on Monday.

Material from former The Daily World reporter Matthew N. Wells’ April 25, 2024, Sept. 12, 2024, and Sept. 30, 2024, articles was used for this story.