A solution as simple as water

John Packham, Ph.D., is a health policy analyst with the Nevada State Office of Rural Health and the University of Nevada School of Medicine. He is the author of the forthcoming Nevada Rural and Frontier Health Data Book.

When I moved to Nevada, I was surprised to learn from my pediatrician that I would have to give each of my children a daily fluoride tablet because Reno did not fluoridate its drinking water. In contrast to my previous hometown of Baltimore, which has fluoridated its water for decades, no community in Nevada at the time fluoridated public drinking water. While Clark County has moved forward with the fluoridation of its public water supply, Washoe and the remaining 16 counties of the state have resisted fluoridation attempts.


The history of public health in America has often including pitting individual liberty against the public good. In other words, we support public measures that demonstrably benefit us collectively, but we do not necessarily support public interventions if they threaten our individual liberties or rights. Battles over smoking in public places, the use of seat belts, mandatory immunizations and the fluoridation of drinking water are examples of this. When it comes to water fluoridation, however, this resistance flies in the face of a well-established body of clinical and epidemiological research on its safety and efficacy.

The fluoridation of community drinking water is a major factor responsible for the dramatic decline in dental caries or tooth decay in the United States during the second half of the 20th century. While some of this improvement can be attributed to better dental care and dental hygiene, much is simply a result of water fluoridation in most of urban America.

Water fluoridation remains the most equitable and cost-effective method of delivering fluoride to an entire community. Fluoridation is an intervention that does not discriminate on the basis of dental insurance coverage or access to dentists (historically in short supply in Nevada). It is a benefit available to every member of the community with a faucet or tap. Fluoridation is cheaper—per person per year—than a dozen Krispy Kreme donuts.

Despite the hoary anecdotes of fluoride’s opponents and their selective reading of the scientific data, the safety of fluoridation is well-established. Opponents of water fluoridation have claimed that fluoridated water is associated with increased risk for cancer, Down Syndrome, heart disease, osteoporosis and bone fracture, HIV/AIDS, low intelligence and allergic reactions, to name a few. Some of the legislative testimony I’ve heard in Carson City would make Oliver Stone proud. Rather, repeated evaluations of water fluoridation find no credible evidence supporting an association between fluoridation and any of those health problems.

It’s clear that water fluoridation is a major factor responsible for the decline in tooth decay for millions of Americans. Yet the residents of Reno-Sparks and most communities in Nevada do not enjoy the benefits of a solution as simple as water. The time has long since passed for the residents and voters of Washoe County to enter the 20th, er, 21st century.