After public debates spanning half a human lifespan, Portland, Oregon, has finally elected to fluoridate its water. Portland's city council has voted unanimously to add fluoride beginning in 2014, at a projected cost of $5 million.
By any strictly scientific calculus of public health costs and benefits, this is an easy and obvious decision. The Centers for Disease Control and Prevention rank fluoridation among the 20th century's ten most significant advances in public health. Citing Brian A. Burt & Steven A. Eklund, Dentistry, Dental Practice, and the Community 204-20 (1999), the CDC has observed:
Fluoridation of drinking water began in 1945 and in 1999 reaches an estimated 144 million persons in the United States. Fluoridation safely and inexpensively benefits both children and adults by effectively preventing tooth decay, regardless of socioeconomic status or access to care. Fluoridation has played an important role in the reductions in tooth decay (40%-70% in children) and of tooth loss in adults (40%-60%).
In an open letter to his constituents, Mayor Sam Adams defended fluoridation on classic, straightforward grounds of social justice. Tooth decay, the mayor wrote, disproportionately afflicts poor and minority populations. Young children are especially vulnerable to tooth decay; those who suffer from it face negative lifelong consequences for their health and for their economic well-being. At $5 million, fluoridation may be Portland's most cost-effective way of delivering a positive dental health benefit to its citizens, especially the most socially vulnerable.
The public backlash in this proudly liberal city will undoubtedly be fierce. Given an opportunity to vote on fluoridation, Portlanders voted "no" in 1980. For all their trouble and their prudent acts on behalf of public health, Mayor Adams and the city council members who finally propelled Portland into the