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The Sonoma County Board of Supervisors on Tuesday is set to advance one of its most hot-button projects: a bid to introduce fluoride to most of the county's drinking water to improve dental health.

A new county report concludes that move, though still in its study phase, would be feasible, although it could also be complex and expensive.

The issue has been at the center of a long-running local debate, pitting medical experts and other supporters against critics skeptical of government-driven health initiatives and mainstream science.

The new report could bring fiscal watchdogs into the mix.

Based on preliminary estimates, the project could cost up to $8.5 million in capital upgrades to the county's central water system, plus ongoing upkeep starting at $973,000 a year, the report found. It was released Thursday and authorized by the Board of Supervisors last year.

The project would affect three quarters of the county, including 350,000 residents served by the Sonoma County Water Agency in Windsor, Santa Rosa, Rohnert Park, Cotati, Petaluma, Sonoma, Forestville and the Valley of the Moon. More than 50,000 Novato-area residents served by the county Water Agency also would get fluoridated water for the first time.

Pam Jeane, an assistant general manager at the Water Agency, called the project's cost "significant" while noting that projects this summer, including aqueduct, pipeline and creek restoration work, are set to cost a total of at least two to three times more.

The potential impact on ratepayers is unknown. At least one Water Agency customer -- the district serving the Novato area -- contends state law forbids such costs being passed on to ratepayers. The district could challenge the move partly on those grounds.

The Board of Supervisors on Tuesday is set to authorize additional financial analysis and engineering studies, at a cost of about $103,000. A final decision on water fluoridation could come late this year or in early 2014.

The latest interim step has reignited the decades-long local debate among supporters and opponents of water fluoridation for dental health. The standoff is likely to continue through two public meetings, including the Tuesday afternoon hearing before supervisors and one today, from 3:30 to 5 p.m. inside a county health office at 3313 Chanate Road in Santa Rosa.

Officials say water fluoridation would be a key way to combat what they've called a dental health "crisis" in Sonoma County. Studies have shown high rates of dental disease in the area, affecting especially low-income and minority children.

"We have a huge oral health problem," said Dr. Lynn Silver Chalfin, the county's health officer, who oversaw the new report to county supervisors.

Fluoride is a chemical compound and was introduced to U.S. drinking water nearly 70 years ago. About three-quarters of the nation's population served by public water systems -- or about 196 million people -- are now receiving fluoridated water.

The measure is backed by the Centers for Disease Control and Prevention, the surgeon general, the World Health Organization and the American Dental Association, which called it "the single most effective public health measure to prevent dental decay."

But opponents of the county's proposal continue to raise concerns about the health and environmental implications of fluoridated water. They cite studies found online and points promoted by a vocal national campaign that opposes municipal water fluoridation.

The topic has dominated a recent wave of letters to the county and lit up an online bulletin board frequented by local activists opposed to water fluoridation.

Mainstream experts say their concerns are largely overblown or taken out of context -- in some instances from halfway around the world, where levels of naturally-occurring fluoride are many times higher than what's allowed here.

Health problems, including cases of fluorosis, a cosmetic staining and pitting of the tooth surface caused when someone consumes too much fluoride, are rare in the United States, experts say.

"I hear the concerns," said Francisco Trilla, chief medical officer of the Santa Rosa Community Health Centers and member of the county's task force on oral health. "As a doctor, I can tell you I am not aware of a single long-term health outcome that is of concern. I know of no reason to be concerned about what's being proposed. It has my full backing."

Critics dismiss those assurances and the long list of expert endorsements, saying the risks -- perceived or real -- should steer the county away from fluoride and toward a greater focus on dental care access and education.

"Why do it when we have other options?" said Brenda Adelman, a Guerneville resident and longtime activist on Russian River water issues.

County officials say they are working on those options as well, pointing to ongoing projects promoting expanded access to dental care, preventative treatments and education. Several new efforts are going to the Board of Supervisors on Tuesday for approval.

Critics also accuse the county of overstating and dramatizing unmet dental care needs to push through an unpopular initiative.

The issue resurfaced in 2009, when a county survey found that 52 percent of Sonoma County third-graders had a history of dental decay, exceeding the state average.

The same study found that low-income kindergartners and third-graders had more than twice the level of untreated decay (21 percent versus 9 percent) as more affluent children. Nearly 7 percent of the children were found to be in need of "urgent" care.

Dentists say they see a need for fluoridated water on a daily basis.

"There's no silver bullet for dental disease. But water fluoridation is definitely one of the tools," said Stephen Chadwick, a Guerneville dentist with the non-profit West County Health Centers, which serves a large number of low-income and uninsured patients.

State law requires fluoridation for all public water suppliers in California with more than 10,000 connections. The unfunded 18-year-old statute has not been widely enforced.

Currently in Sonoma County, the only fluoridated water is delivered to residents of Healdsburg and the adjacent Fitch Mountain area.

Public comment at today's meeting will be accepted at 4:05 p.m. Tuesday's hearing also will be open to public comment.

You can reach Staff Writer Brett Wilkison at 521-5295 or brett.wilkison@pressdemocrat.com.

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