Davie County ends water fluoridation after supply chain problems

By Anne Blythe

On the first of September, Davie County will join the list of North Carolina community drinking water systems no longer adding fluoride to their supplies.

Unlike the handful of other counties that considered ending system fluoridation, the decision in Davie County had a new twist. Pragmatic decisions about international supply chain problems played as large a role as the more typical fluoride debate — new concerns over potential health risks versus established dental science that shows the process to be a successful public health measure for preventing tooth decay. 

The board of commissioners of the rural-suburban central Piedmont county unanimously adopted a resolution Aug. 3 to suspend the use of fluoride additives after learning about Middle East supply chain issues that made it more difficult to safely get the chemicals.

Brian Barnett, Davie county manager, told NC Health News in a phone interview this week that its chemical vendor relied heavily on Israel for inventory.

Johnny Lambert, Davie public utilities director, shared a letter with NC Health News this week from Coyne Chemicals that went into greater detail about the supply challenges.

Coyne’s supplier, ICL, or the Israel Chemicals Limited Group, told the company on Feb. 16 of its intent “to abruptly exit” the U.S. market.

“As you may know, our supplier of this product is located in Israel,” the letter states. “They have advised us that they have been severely impacted by the war in the Middle East and have lost a large part of their workforce as a result of those individuals being called into active military service.”

That resulted in production problems over the past year, according to the letter. The staffing problems resulted in a decision “to forego operations that allow them to provide us this product in the United States.”

Thomas Coyne Sr., president and CEO of the chemical company headquartered in Croydon, Pennsylvania, said his organization had made “diligent attempts” but was unable to find other suppliers of hydrofluorosilicic acid, the liquid chemical added to municipal water supplies.

The company declared a force majeure, a legal safety net clause that excuses a business or party from liability issues due to extraordinary, unforeseen and uncontrollable circumstances such as a natural disaster or war.

Not unique to NC

Supply chain issues have affected other water systems across the country.

In April, the City of Baltimore cut its fluoride levels nearly in half, according to NPR, after its supplier reduced deliveries.

Several Louisiana cities recently halted their water fluoridation because of supply chain issues, according to local TV news reports.

Milwaukee reported halving the amount of fluoride it added to its drinking water earlier this month.

Many of these decisions across the country have called for temporarily altering fluoridation processes until the supply chain issues can be resolved.

Beyond the Middle East conflict

Davie County’s decision also takes into account public health concerns that prompted Union and Lincoln counties to ban fluoride in their public water systems.

Fluoride skeptics — including Robert F. Kennedy Jr., the U.S. Secretary of Health and Human Services — have relied on a study published in JAMA Pediatrics finding that fluoride exposure can have a detrimental impact on the cognitive function of children. Community fluoridation advocates point out, though, that the study looked at countries with much higher levels of fluoride than is used to treat water in the United States.

Furthermore, research has shown that drinking fluoridated water reduces cavities by about 25 percent in children and adults, according to the Centers for Disease Control and Prevention, an effect that benefits low-income residents in particular.

Lambert, the public utilities director, said community members have expressed concerns about health effects. Also, he said, employees at the water treatment plant worried about the safety of handling fluoridation chemicals.

The commissioners also considered the ability of county residents to make individual choices about fluoride consumption, since the additive is available in toothpaste, mouth rinses and professional treatments applied at dental offices. Lambert said his department heard a range of opinions.

“I would say it was about 50/50, people for and against it,” Lambert said.

Andrew Rivers, a dentist in Davie County for 14 years, urged commissioners at their Aug. 3 meeting to continue adding fluoride to the water system. Rivers has cared for patients, he said, that grew up without consistent access to preventable dental care and seen “children with severe tooth decay, adults who have lost teeth far too early, pain, and in some cases even hospital visits and life-threatening infections.”

“This all can be prevented,” Rivers told the commissioners. “Community water fluoridation is one of the most thoroughly studied public health measures for our country. For decades, the overwhelming body of scientific evidence has supported its safety and effectiveness when used in recommended levels.”

For many families, Rivers added, community water fluoridation is “a safe and affordable way to help protect oral health. In my experience, the greatest benefits are often seen in those who have the fewest resources.”

Ultimately, the board decided “that discontinuing the addition of fluoride to the public water supply is in the best interests of Davie County and its residents,” according to the resolution forwarded to the state Department of Health and Human Services and the state Department of Environmental Quality.

When asked whether the decision could be reversed at some point, Barnett, the county manager responded: “The beauty of county commissions is anything they do can be undone, but they have to do it with a vote. In all theory, a board could one day reverse it.”

For now, though, Davie County is the third North Carolina county to officially eschew fluoridation of its community water system.

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