Fort Smith and Eureka Springs are not a lot alike. Fort Smith is among the most socially conservative cities in Arkansas, prime teabagger territory, while Eureka Springs is definitely the most socially progressive, with its marriage certificates for same-sex couples, and its open arms for any group that wants to party there, transvestites or Hell's Angels.
But Fort Smith (pop. 86,209) and Eureka Springs (pop. 2,073) share an aversion to fluoride in their drinking water. Residents have voted against fluoridation at least twice in both cities. And now they'll both be getting fluoride despite those votes, like it or not.
In March, the legislature approved Act 197 of 2011, requiring fluoride in all water systems that serve 5,000 people or more. (Eureka is the smallest customer in the Carroll-Boone Water District, which also serves Harrison, Green Forest and Berryville. The water district board had allowed Eureka's opposition to keep fluoride out of the water that goes to all four cities.)
After years of study of its cavity-fighting properties, fluoride began being used in public water systems in America in the 1940s. By the '60s it was common, although there were still pockets of resistance, people who argued that its effectiveness hadn't been proved or that fluoridated water was dangerous and shouldn't be forced on people who didn't want it. In the Cold War years, opponents argued that fluoridation was a communist plot, but that one's not heard much anymore.
State Sen. David Johnson of Little Rock was the lead sponsor of Act 197. Little Rock's water has been fluoridated for 60 years, but Johnson said he became convinced that everyone should have fluoride after reading a report on dental health done by the Pew Research Center, a Washington think tank. The state Health Department had been calling for a statewide fluoridation bill for years, and in 2005 the Senate passed a fluoridation bill that died in the House of Representatives. Johnson said he'd worked diligently to build a coalition this time. Indeed, counting Johnson, 18 senators signed on as co-sponsors of the bill, enough to pass it through the Senate by themselves. An unusually large number of representatives signed on too.
Johnson said it was crucial that no water system would be required to spend its own money for fluoride equipment and installation. Delta Dental Foundation is doing that. The cost of the fluoride itself is slight, Johnson said.
The non-profit Foundation is associated with Delta Dental, a for-profit dental health insurer. The Foundation has pledged to spend at least $2 million; the work has already begun at some water systems. Presumably, Delta Dental believes fluoridation will save the company money in the long run. "They support public health," Dr. Lynn Mouden said. "They understand that prevention is cheaper than treatment."
Mouden is the director of oral health for the Health Department. "The overwhelming body of scientific evidence proves that fluoridation of community water systems is safe and effective," Mouden said. He said that 64 percent of Arkansans already have access to fluoridated water. Act 197 will bring the figure up to 87 percent.
Mary Pat Boian is the editor of the Lovely County Citizen, a lively weekly newspaper at Eureka Springs. Just as Eureka Springs is unique among small Arkansas towns, the Citizen is unique among small-town newspapers. It sometimes leans to the left, but it has editorialized against fluoridation. Boian is still not sure that fluoridation will actually come to Eureka, despite the new law. "They're kind of dragging their feet at the Carroll-Boone Water District," she said. "People don't want to be mandatorily medicated."
"We've been opposed to fluoride for years," Boian said. "We get letters from the other side, but nothing that persuades us fluoride is necessary." She said that Delta Dental was paying only part of the cost of fluoridation. "So the rest of it will likely come from higher water rates. How much do we want to pay to poison ourselves?"
Fort Smith voters rejected fluoridation in 1970 and 1992. But after the passage of Act 197, the Fort Smith City Council voted 5 to 1 to proceed with fluoridation on receipt of a Delta Dental grant.
A sort of last hurrah came from state Rep. Denny Altes, R-Fort Smith, who is among the most conservative of legislators. He asked Attorney General Dustin McDaniel for a legal opinion on whether Act 197 was constitutional as it applied to Fort Smith, where voters had turned down fluoridation twice. McDaniel said the statute was constitutional.