When I moved to Portland earlier this year, one of the first surprising things I learned about my new home was that it doesn’t fluoridate its water. I got the heads up from my neighbor who mentioned it in a text. He said that the no fluoride issue catches a lot of people new to Portland off guard.
He was right. My first thought was, “Oh, no! My teeth!” My second was, “Wait, why?”
A few rabbit hole Google searches later into the issue and it became clear to me that, pre-pandemic/racist reckoning times, there were few things as divisive in Portland as the debate over fluoride. Depending on who you talk to, it’s either a public health savior or public enemy No. 1.
Here are the basics on fluoride. It's a common, naturally occurring mineral that's found just about everywhere, according to the Centers for Disease Control. It's in the air. It's in the soil. And in most places in the U.S., it's added to the water. That's because numerous studies have shown fluoride, in small amounts, significantly reduces tooth decay. The 75-year-old practice is backed by the CDC and The American Dental Association.
But things get a little weird in Portland, the largest city in the nation that does not fluoridate its drinking water. And Mort Anoushiravani knows all about how Portlanders feel on the issue. He spent 26 years with the Portland Water Bureau, starting out as a water engineer and working his way up through the ranks. Anoushiravani headed up the agency from 2001 to 2005.
“Portlanders have basically told [the water bureau] several times, loud and clear, that they don't want [the PWB] to use drinking water as a medication route for dental health,” said Anoushiravani, who is now the global director of infrastructure at Portland-based nonprofit Mercy Corps.
The last time Portlanders let their voice be heard on this issue was in 2013, when voters handily rejected a measure that would have allowed fluoride to be added to its water. Before that, voters said no to fluoride three other times in 1956, 1962 and 1980.
"We are somewhat unique in terms of voting it down," said Rick North, the volunteer chair of the advisory committee for the anti-fluoride nonprofit, Fluoride Action Network or FAN. "We're the largest city in the country that has voted it down."
Arguments against fluoride run deep in Portland, a city that prides itself on its First Amendment rights and its pristine H2O from the Bull Run watershed. (But it's worth noting that last year, City Council approved a contract to build a new water filtration plant that will treat the two reservoirs for the parasite cryptosporidium.) Even well-known environmental groups like the Sierra Club have publicly opposed fluoridation in Portland. North said the most compelling case to not fluoridate drinking water stems from studies that have shown some negative health effects from fluoride.
“Our biggest concern is safety,” North said. “If you put [fluoride] in the water, there's no way to control how much you're going to get.”
Another popular argument against fluoride calls attention to flaws in the studies that have lauded the benefits of the mineral. (Although the same can be, and has been, said for studies that resulted in adverse effects.)
North also pointed out that this debate is in federal court now. A federal judge in California is considering a case brought on by anti-fluoride groups, including FAN, against the Environmental Protection Agency. The plaintiffs allege fluoride is a neurotoxin and the EPA should regulate it. The case is currently paused until August while the court considers new data on the subject.
Despite the many arguments against fluoride, nearly 73% of all U.S. citizens have access to fluoridated water, according to the CDC.
A spokeswoman with Multnomah County, which encompasses Portland, said the county’s official stance on fluoride remains the same from 2012: strong support. That year, former Multnomah County Health Officer Dr. Gary Oxman backed fluoridation in written testimony to Portland’s City Council. In the letter, Oxman noted that the potential health concerns of fluoride do not outweigh the benefits of it:
"Concerns about adverse health effects are no reason to delay. Instead, a responsible public health approach is to move ahead with fluoridation and continue to actively seek out and evaluate emerging scientific evidence about potential adverse consequences of fluoridation."”
Ultimately, the issue of fluoridation is not something for the county to decide. That’s up to Portlanders. And whether it’ll be brought up again in the city is anyone’s guess. But here’s some advice from Portland Water Bureau veteran Anoushiravani: Never say never.
“If an organized and compelling case can be made, I'm sure it may appear on the ballot again,” Anoushiravani said. “But it’s an issue that needs population support. It has to be demanded by the people.”
Hear the full conversation on fluoride in Portland in the audio player above.