A study last year revealed that an alarming number of children in Sonoma County are suffering serious dental health problems. The report showed that almost half the county's kindergarteners and about 60 percent of its third graders had experienced some form of tooth decay. More importantly, 16 percent of the children showed untreated tooth decay, with a much higher percentage for lower-income children. Poor and Latino children were shown to have over twice the rate of dental disease of wealthier or white children.

The study, which cited "a staggering burden of suffering and a growing oral health divide between rich and poor," has been the impetus for a multi-pronged program aimed at improving dental health countywide, with a particular emphasis on helping low-income and Latino children.

Increasing public education and outreach programs on the benefits of proper oral hygiene and improved diet, along with school-linked dental sealant programs targeting lower-income children less likely to receive private dental care, are both good solutions. Increasing access to dental care for lower-income children, with programs such as the Petaluma Health Center's free dental exams for kids, also makes sense.

But the most far reaching and controversial element of the county's program to improve the dental health of impoverished children is the fluoridation of the water supply serving all cities in the county, including Petaluma.

Citing numerous studies over several decades, county public health officials claim fluoridation "is the single most cost-effective and equitable approach to improving dental health." Depending on the study cited, fluoridated water supplies are credited with reducing tooth decay by between 20 and 40 percent.

Fluoridating public water supplies began in the 1950s, and today more than 70 percent of the country's population lives in communities served by fluoridated water systems. The practice has long been supported by the National Centers for Disease Control and Prevention, the World Health Organization, the U.S. Dept., of Health and Human Services and the American Dental Association. One CDC study stated that every dollar spent on public water fluoridation results in $38 savings in dental expenses.

Given all the data in support of fluoridating the county's water supply, it's no surprise that the Board of Supervisors last week voted to authorize engineering studies on developing a countywide fluoridation system along with an analysis on how the construction and operation of such a system would be financed.

But not everyone is convinced that the money spent on such a project would yield the kinds of big dividends promised, while others are fearful of perceived environmental and health impacts from putting a chemical compound, albeit a preventative medication, into a public water supply.

While there is no clear data suggesting that properly fluoridated water represents any significant health or environmental threat, there are very legitimate concerns among residents in Petaluma and elsewhere on whether paying higher rates will, in fact, ensure we achieve the goal of delivering an optimal level of fluoridated water to all residents served by the county system.

Most studies on the efficacy of fluoridated water, for example, were done long before Americans began the habit of consuming large volumes of bottled water. According a USDA study completed in 2008, showed that nearly 50 percent of the water intake for Americans between the ages of 20 and 39 comes from bottled water, as opposed to tap water.

Partly due to the increased popularity of bottled water and sugar-sweetened carbonated beverages and fruit drinks, children between the ages of 2 and 11 now consume, on average, just one cup of tap water per day. Will consuming just one cup or less of fluoridated tap water daily provide enough fluoride to significantly improve a child's dental health? What about the estimated 24 percent of children who don't drink any tap water during the day? If they are among the same target group with very poor oral health, and they probably are, how will they be helped if they are not consuming any fluoridated water?

Aside from the wide range of personal tap water consumption behaviors, there are many other significant variables, depending on which water system is being used, that make it almost impossible to deliver the proper daily dosage of fluoride to each consumer. Petaluma, for example, draws approximately 10 percent of its drinking water from underground aquifers; that practice will dilute the fluoride level for local consumers. People in Rohnert Park and Cotati get 25 to 30 percent of their water from local wells, so dilution rates there will be even higher, while Windsor, which gets nearly 90 percent of its water from wells, will get nearly no fluoride in its drinking water.

Since the goal in fluoridation is to provide optimally fluoridated water to all customers of a water system, the only practical solution would be to build individual fluoridation facilitates for each city and local water system. Is Petaluma prepared to finance such an undertaking, while its ratepayers are already paying for a new countywide fluoridation system estimated to cost $9 million to being and nearly $1million annually to operate?

Especially since the county recently announced a five percent wholesale water increase for cities effective July 1 to cover planned upgrades to the water distribution system, and with more increases expected in years ahead, ratepayers in Petaluma and elsewhere must decide if they believe the costs of fluoridating the water supply, both at the county level and possibly locally, are worth the perceived benefits.

At this point, there's not nearly enough data available to make such a decision.