Dover Community Services System Operator Jamie Stevens checks fluoridation equipment at one of the city's water treatment facility. [John Huff/Fosters.com] ▲ Sodium fluoride is added and monitored to the public water supply at one of the city of Dover's water treatment facility. [John Huff/Fosters.com] ▲ Sodium fluoride to be added to Dover's public water supply is stored at one the city's water treatment plants. [John Huff/Fosters.com] ▲ Sodium fluoride is added and monitored to the public water supply at one of the City of Dover's water treatment facility. [John Huff/Fosters.com] ▲

CONCORD — A group of Republican state representatives are hopeful this could be the year the Legislature bans the addition of fluoride in municipal water supplies.

On March 12, the House Resources, Recreation and Development Committee voted 16-3 to recommend passage of House Bill 192, sponsored by Republican Reps. Richard Marple of Hooksett and Raymond Howard of Alton. HB 192 would prohibit the introduction of fluoride in municipal water systems. The vote carries significance because since 2011 four bills banning the chemical's use by cities and towns operating public water systems have been killed in committee by unanimous or near unanimous votes against them each time.

The bill has since been tabled this week, but Howard said he and his co-sponsor could pull the bill from the table and put it to a floor vote before the entire House at a later date.

"Fluoride is the only medicine we put in our water and people can get fluoride by other means," Howard said Thursday. "There's definitely momentum behind this."

Proponents of continuing the practice point to the Centers for Disease Control and Prevention's recommendation to fluorinate water as a safe and cost-effective method of preventing tooth decay, especially among children from infancy to age 12. According to the American Dental Association, every dollar invested in water fluoridation saves $38 in dental treatment costs.

Dr. William McDowell, director of the University of New Hampshire's N.H. Water Resources Research Center, said the sole purpose of adding fluoride to water is for the public's dental health benefits. He said only high concentrations of fluoride would be harmful in the form of teeth discoloration. He added that a bigger concern is the fluoride concentration in private wells because there are no statutes requiring them to be tested.

"Excessively high concentrations, five times, 10 times the levels in public water would pose health issues," McDowell said. "A lot is added to water whether it is to maintain pH levels, manage its hardness. If the Legislature decided it's no longer needed to fluorinate water, it wouldn't have any other effect (on public water) besides eliminating the dental health benefits."

Supporters of eliminating fluoride in public water argue there are several consumer products, such as toothpaste with added fluoride, which adequately meet dental health needs of individuals and make fluorinating municipal water irrelevant or possibly even over-dosing individuals who use fluoride products and use fluorinated public water.

According to a 2015 report by the Cochrane Collaboration, cited in a 2016 "Harvard Public Health" article, researchers found early studies on the benefits on adding fluoride to public water were "deeply flawed" because many were done prior to 1975 and failed to account for the use of fluoride-containing toothpastes and other dental supplements designed to reduce cavities.

The Cochrane report compares countries with and without fluorinated public water, such as Canada, Germany, Japan, Sweden and Switzerland, and generally found the trend lines were virtually the same reflecting the average number of decayed, missing for filled teeth before an individual turned 12. From 1975 to 2012 the number in the United States dropped from an average of three teeth to one, while Switzerland experienced a similar decrease over the same time period.

Rep. Valerie Fraser, R-New Hampton, has co-sponsored several pieces of legislation to ban fluoride from public water in the past. She said fluoride is a main elemental component in a number of perfluorochemicals, such as PFOS, PFOA and PNFA; all found in large quantities in groundwater in some Seacoast communities and are suspected to be carcinogens.

"(Fluoride is not meant to be swallowed and ingested. It's already in all the water contained in products like the juices we buy," Fraser, who testified in favor of HB 192, said. "What I don't understand is we've said we're OK with having fluoride in our drinking water, but we've also said it's not OK here because it's considered a contaminant. These chemicals are all fluoride-based."

Fraser said even though fluoride can only be added to a public water supply through local referendum, the issue raises a constitutional question of "forcing medicine" upon those who didn't support the referendum in their community.

"Some residents don't want it and they don't have a choice," she said. "Fluoride filters are expensive, and it places a burden on the individual. The petition process to get a new referendum on the ballot is pretty onerous in the big cities like Manchester, someone would need 2,000 or 2,500 signatures."

According to the bill's fiscal note, 10 municipalities including Dover, Durham, Greenland, Madbury, New Castle, Newington and Portsmouth all fluorinate their water supplies, at an annual cost of $1.75 per person for a population using public water of approximately 289,300 statewide, or an approximate annual cost of $506,275 divided proportionally by town based on population size. Though the fiscal note's text also concedes the state Department of Health and Human Services would have no way of estimating any potential additional costs associated with hospitalization or medical treatment for tooth decay, and any increased costs from Medicaid associated with passage of the bill would be split between the general fund and federal funds.

John Storer, director of community services for Dover, said the city spends roughly $10,000 to $12,000 annually on fluoride chemicals alone. He said fluoride pumps and analyzing equipment cost another $8,000 to maintain and another $1,000 for water testing, annually.

Storer said he had no opinion on whether or not Dover should be adding fluoride to its water.

"We've had a couple inquiries asking how to get a referendum question on the ballot (to stop using fluoride)," Storer said. "If the state bans it, we'll stop buying it. It'd be one less chemical for us to put in the water, so we're waiting with curiosity."