A tale of two cities, both successful in keeping water fluoridation

'I will defend fluoridation because of the good it does’

Both Abilene, Kansas, and McVille, North Dakota, are among the latest municipalities that faced the end of their communities’ water fluoridation in an era when anti-fluoridation challenges have become increasingly rampant.

But both were able to stave off the termination of the public health programs through the activism of dentists, residents and oral health organizations like the ADA to keep what the Centers for Disease Control and Prevention call one of 10 great public health achievements of the 20th century.

“Abilene is the latest in a string of … politicians playing politics with an apolitical health issue.,” said Johnny Johnson, Jr., D.M.D., president of the American Fluoridation Society. “Abilene showcases how the politicians in Collier County, Florida, Union County, North Carolina, the states of Kentucky, Georgia, Nebraska, and New Hampshire have behaved. [It’s] a powder keg right now [and it is important] to educate those in our field about how to fight for the prevention of the disease for which our profession exists.”

Abilene, Kansas

Abilene is best known for being where Dwight Eisenhower grew up before he entered the military and became a general and later U.S. president.

It attracted attention in 2024 when the Abilene City Commission voted 3-2 to end its community water fluoridation.

But, weeks later, the commission reversed itself, voting 3-2 to continue fluoridation after a key councilmember changed her vote.

Tanya Dorf Brunner, executive director of Oral Health Kansas, a consumer oral health advocacy organization based in Topeka, was involved in the pro-fluoridation advocacy.

“When the issue was first raised for a vote, [the councilmember] made a motion to delay for two weeks in order to learn more,” Ms. Brunner said. “Local advocates worked hard to share more information about water fluoridation after the Commission voted to stop. When they brought the issue up again to consider reinstating fluoridation, she indicated she had learned more and now understood the issue better. She also said she does not like to tell people what to do, so she was not excited about voting to fluoridate, but she said the evidence does show people will be harmed if fluoride is stopped permanently.”

Bea Brittan, D.D.S., moved back to her hometown of Abilene in January to practice. She was alarmed when the city commission voted to stop fluoridating its water.

“For the well-being of my patients, and everyone in my hometown, particularly those most vulnerable like children and the elderly, I knew I could not sit back as a dental professional and watch this happen,” Dr. Brittan said. “I grew up in Abilene. My teeth benefited from water fluoridation. It seemed cruel to deny that public health benefit to future generations of kids in Abilene.”

She wrote a letter to the local newspaper and spoke at both meetings — both for the vote to abolish fluoridation and the one that restored it. She became known for being one of the faces of the movement.

Dr. Brittan also contacted the ADA, which helped put her in touch with other advocacy groups like Oral Health Kansas, the American Fluoridation Society and the American Academy of Pediatrics to support her efforts.

“I had five people alone approach me while I was in the chair getting a manicure, not to mention the stops in the grocery store, church and any other place I go,” Dr. Brittan said. “It's been pretty much constant every time I leave my house, both while the discussion was going on and after the vote. It's all people either saying thank you for my advocacy or saying something like, ‘What in the heck is the commission thinking?!’”

“The decision to cease fluoridation was based primarily on a ‘personal freedom’ argument,” said Matt Jacob, a communications consultant for the American Fluoridation Society. 

Dr. Brittan agreed that politics played a role in the city’s decision to halt fluoridation.

“Their own personal beliefs about the role of government were what was cited as their opposition to fluoridation,” she said. “I do not want to assign any nefarious intent to the city commission, but I also believe based on my meetings with commissioners after their vote to stop fluoridation that their own extremely misguided beliefs about the efficacy of fluoridation, the science behind it and dental health in general also played a role. It's hard to argue with someone who clearly doesn't trust an overwhelming majority of science that points to the efficacy of fluoride.”

Kevin J. Robertson, executive director of the Kansas Dental Association, said the KDA has always been involved with efforts to fluoridate communities in Kansas.   

“[Our] basic message was that the KDA supports community water fluoridation as a safe, effective and cost-saving way to prevent tooth decay,” Mr. Robertson told ADA News. “Fluoride is not a medication — it is a naturally occurring mineral found in soil, food and some water sources. Community water fluoridation benefits everyone, especially those without access to regular dental care.”

McVille, North Dakota

McVille is home to only 417 people, but the municipality was the epicenter of one of the state’s largest debates about fluoridation in recent times.

In 2019, McVille was honored with an award from the ADA, Association of State and Territorial Dental Directors and Centers for Disease Control and Prevention for 50 years of continuous community water fluoridation.

But in late 2023, McVille was the first city in North Dakota to cease fluoridation, voted on by the city council.

Jim Kershaw, water superintendent of Bismarck, North Dakota, is a staunch advocate for fluoridation, and knew who to call: Dr.  Johnson.

“Johnny was asked in McVille why a dentist from Florida would come to a town of 400 people,” Mr. Kershaw said. “His reply was, ‘It doesn’t matter if it’s a town of 400, 4,000, 40,000 or 400,000, I will defend fluoridation because of the good it does.’”

Dr. Johnson and Mr. Kershaw were not the only people who were there to educate the community and council on why fluoridation was necessary to keep tooth decay at bay. North Dakota dentists Kristen Kenner, D.D.S., and Jackie Nord, D.D.S.,a member of the ADA Council on Advocacy and Prevention, among others, were on the team pushing for fluoridation.

“I feel passionate about keeping fluoridation in city water sources since I have seen in my 39 years of practice what happens to those who do not receive fluoride.” Dr. Kenner said. “Living in rural North Dakota, I frequently saw the decay rate increase on children that only drank well water on their farms with no fluoride. Unfortunately, the communities that are removing fluoride from their water sources will soon show the devastating results of decay increasing significantly especially in the younger population.”

Banding together was vital to the effort, Dr. Nord said.

“I think once members of the community saw how strongly local dentists and national dental leadership felt towards water fluoridation, they paused and really thought about the facts,” Dr. Nord said.

“It certainly takes a village,” said Cheri Kiefer, Oral Health Program Director, Health Promotion & Chronic Disease Unit, North Dakota Department of Health & Human Services. The ADA and the North Dakota Dental Association also supported the effort. 

Ms. Kiefer and Vanessa Bopp, a dental hygienist colleague at the department, lent support by being present at the city council meeting and reported on the oral health data in North Dakota when requested.

In one statement, they reported to the council that 41% of North Dakota residents live in a rural or semi-rural county.

“People living in rural areas have greater unmet dental needs and may have long travel distances to seek care,” they cited. “Tooth decay is the most common chronic childhood disease. One in two kindergartners has experienced tooth decay… The number of children in Head Start, kindergarten, and third grade who need dental treatment would fill 115 school buses.”

In the end, the council overturned its decision and voted to reinstate fluoridation.

“The council member who’d led the cessation was the one who eventually made the motion to resume fluoridation,” Dr. Johnson said.

Mr. Kershaw added, “With proper education and common sense, they saw the light.”

Dr. Johnson said collaborative efforts can and do have major impacts in education of all interested parties in individual communities. 

“It does have an impact and in this situation in particular, led to the reversal of a bad decision,” he said.

Will Sherwin, executive director of the North Dakota Dental Association, is working with the ADA, AFS, and local agencies to develop pro-fluoridation packages for fluoridation advocates “as we see the fluoridation issue becoming more contentious and prevalent in our state,” he said.