© Don Ryan/Associated Press
While some residents questioned the science of fluoridation, more said the decision should be put to a public vote.
Portland, Oregon, which never fluoridated its water supply and over time earned the distinction as the biggest city in the country to just say no, reversed course on Wednesday with a unanimous vote by the City Council to add fluoride beginning in early 2014.
, which will cost the city about $5 million to carry out, was seen by both supporters and opponents as fraught with significance. Many Portlanders treasure their city's quirky distinctiveness. Others said its leadership role as the largest city in a state that is mostly nonfluoridated - and has some of the worst tooth-decay problems in the nation, according to various medical studies - made the new course long overdue.
The city's water system serves about 900,000 people, or almost one-fourth of Oregon's population, including some in communities outside the city limits.
"It isn't just time for Portland to enter the 21st century - we have some business to make up from the 20th century," said Randy Leonard, the public safety commissioner, who was interrupted several times by shouts from the audience. "This is not an issue for the faint of heart."
Hundreds of people converged on City Hall last week for a public hearing lasting more than six hours, and residents once more packed the council chambers on Wednesday as the five commissioners, including the mayor, Sam Adams, explained their reasons at length before casting their votes.
The politics of fluoride
have always been complicated. In some places in years past, opponents saw Communist plots. In Portland, social policy and health policy melded as residents and elected officials debated whether adding the compound in tiny quantities would reflect the liberal social goals that the city had become famous for, sometimes to parody.
Mr. Adams specifically said in an open letter to residents that his support for the idea was based on the social equity goals that he said it would advance and that he had been elected to achieve. Tooth decay
, he said, is disproportionately a problem of the city's poor and its minority populations, with research showing that young children suffering from poor dental health miss more school and fall behind.
Opponents said the science on fluoride, despite more than half a century of experience in some American cities, was still uncertain. But an equal or greater irritant, many said, was that the council was moving ahead without a public vote, and on an accelerated schedule - fluoridation is to be put into effect in only about 18 months - which could make a public ballot challenge difficult.
Portland last considered - and rejected - fluoridation in a referendum in 1980.
The commissioner of public utilities, Amanda Fritz, a former nurse, said that some complaints about the council's work on the issue were valid, including those of neighboring communities that said they were not consulted. She was also troubled that questions about the process had overshadowed a debate on the medical merits.
"The way we get there does matter," she said. But she added that everything in her background as a nurse and mother, combined with what she had learned in preparing for the vote, convinced her that fluoridation was the right course.
Fluoride in low quantities is natural in most fresh water supplies, including Portland's. Boosting the level to around 0.7 parts per million, though, has been found by numerous studies to help protect teeth from cavities.
The Centers for Disease Control and Prevention has called the introduction of fluoride in municipal drinking water after World War II
one of the 10 greatest achievements
in public health of the 20th century, up there with vaccination and motor vehicle safety improvements.
But even as the commissioners explained their positions, some audience members held signs on their laps for the cameras, in vigils of mute protest. "Public water public vote!" the signs said.