Special Reports

Cavity-prone kids aren’t getting fluoride in drinking water across SC

Many South Carolina utility companies don’t add fluoride to the tap water people drink. Dentists say this increases tooth decay patient numbers, and that the poorest residents suffer with high dental work bills.

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Every day or two, a patient walks into Kent Bracey’s dental practice in pain from a tooth that is so decayed Bracey must pull it.

“We pull a ton of teeth,’’ said Bracey, a dentist from Dillon County in eastern South Carolina. “We just see a lot of tooth decay.’’

Bracey thinks he would not pull so many teeth if more utilities put fluoride in drinking water. But that’s not the case in many South Carolina communities.

More than 300 utilities, serving as many as 317,000 South Carolinians, aren’t injecting fluoride into drinking water to protect against cavities that can cost them thousands of dollars in dental bills, according to the U.S. Centers for Disease Control and Prevention. That is 55 percent of the community water systems in South Carolina.

Most of the water systems are small ones, serving fewer than 10,000 people each. Often they are in out-of-the way communities where poverty rates are high and dental care is lacking.

The lack of fluoride makes people more vulnerable to tooth decay, say dentists who champion the addition of fluoride to water. Studies have shown children in rural areas without enough fluoride in the water have more cavities than their counterparts in urban areas, where most big systems provide fluoride.

Utilities that don’t use fluoride range from tiny city-owned waterworks to systems in mobile home parks.

Unlike big city waterworks with big budgets and staff, some small water systems don’t fluoridate because state and federal laws don’t require it. Some say they don’t have the money to install and maintain fluoride injection systems.

Fluoridating water can cost a utility anywhere from $10,000 to $100,000 annually, depending on the size of the water system, according to dentists and public works officials interviewed by The State.

“It’s a money thing,’’ Florence dentist David Moss said. Fluoride “is a huge benefit to the population, but it still costs to do it.’’

Fluoride levels must be measured because too much can turn people’s teeth brown. Not enough fluoride, makes teeth more vulnerable to decay, according to the S.C. Dental Association.

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Kent Bracey, a dentist in Dillon, pulls a lot of teeth partly because of a lack of fluoride in the community water system. 2/25/19 Tracy Glantz tglantz@thestate.com

Added expense for small systems

Jamie Gradwell said she wishes the West Columbia mobile home park she lives in put fluoride in the drinking water pumped from a well to its tenants.

Since moving there in 2004, cavities have been a regular occurrence for the 42-year-old and her 18-year-old daughter, she said. They have had to buy expensive toothpaste for themselves, while taking extra precautions to ensure her 3-year-old grandson doesn’t have the same problems with tooth decay.

“I’ve probably had six or seven cavities in the 15 years I’ve been here,’’ Gradwell said, adding she is convinced the lack of fluoride “has a lot to do with it.’’

Of the more than 300 S.C. water systems identified by the CDC as not using fluoride, about a third are small systems in Richland and Lexington counties. Those include the town of Eastover, the Hopkins Community Water System and at least 31 mobile home parks.

Carolina Water Service, a multi-million-dollar corporation headquartered in Chicago that operates a string of small S.C. utilities, says it doesn’t put fluoride into any of its drinking water systems that rely on wells because it isn’t required. Carolina Water Service systems that buy water from large S.C. utilities do have fluoride because it’s put in by those utilities, the company said in an email to The State.

Milton Pope, administrator for the town of St. Matthews, said fluoride is an expense the town has chosen to forgo, particularly after some anti-fluoride groups cautioned against its use. St. Matthews discontinued fluoride several years ago.

“I know lots of towns in the past that used to, but I think there are some questions,’’ Pope said. “A lot of municipal water systems took it out.’’

Despite assurances from an array of researchers that fluoride is a safe way to prevent cavities, some groups are pushing cities not to put the mineral in water, saying it poses a long-term health risk, particularly to children.

In the town of Latta near where Bracey practices, administrator Jarett Taylor said fluoride is an unnecessary expense. The town has more pressing water and sewer needs, such as plugging leaks, he said.

“Our fluoride machine broke down,’’ Taylor said. “I want to say the fluoride machine was several hundred dollars to fix. We were at a point where we were running really tight on cash and we were looking at what could we do to make things more cost effective.’’

The S.C. Department of Health and Environmental Control says most South Carolinians get their drinking water from large systems that inject fluoride.

All told, about 92 percent of South Carolinians served by water systems get fluoride in their water, according to DHEC and the U.S. Centers for Disease Control. Utilities adding fluoride include those serving Columbia, Greenville, Aiken, Rock Hill, Spartanburg, much of Beaufort County and Myrtle Beach.

Cavities galore

Still, the more than 300,000 South Carolinians who don’t get fluoride from their community water systems would make up a city larger than Charleston or Columbia, South Carolina’s largest municipalities. Of the more than 300 water systems not fluoridating, small ones serve 235,000 people.

DHEC studies suggest the absence of fluoride contributes to children’s cavities. Reports have found that needy children in rural areas have had more tooth decay than children in urban areas, where fluoride typically is injected into the water.

A 2012 report on dental health in South Carolina found that 47 percent of the children examined in rural areas had cavities, compared to 37 percent in urban areas. The report also found 21 percent of the children screened in rural schools had untreated cavities, compared to 9 percent in urban areas. Many of those children with tooth decay problems were low income, the survey found.

Poor dental hygiene in needy communities likely contributes to some of that disparity, but the lack of fluoride doesn’t help, dentists say.

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Kent Bracey is a dentist in Dillon. One of the reasons he pulls a lot of teeth in the rural community is a combination of what patients eat and drink and a lack of fluoride in the community water system. 2/25/19 Tracy Glantz tglantz@thestate.com

A child’s tooth from a community with fluoride “has a shine to it, it has a look to it, a depth of color to it that you see, and typically there is no staining,’’ Aiken County children’s dentist Rocky Napier said. “Kids that come in from non-fluoridated communities, you tend to see more staining. It just doesn’t have that look to it, it just doesn’t have that quality appearance.’’

Toothpaste with fluoride helps, but it isn’t enough in the fight against cavities, dentists say.

That is supported by studies in other states:

In Alaska, a university researcher recently found children in Juneau have suffered more tooth decay since the city stopped fluoridating water in 2007. The lack of fluoride means children will have to go to the dentist once more each year, at a cost of about $300 per child, the Associated Press reported.

▪ In 2003, Colorado researchers found the state saved $149 million in dental treatment costs — about $61 a person — by fluoridating water, the S.C. Dental Association said in a recent report.

▪ In New York, low-income residents in communities with limited access to fluoride needed 33 percent more fillings, root canals and tooth extractions than those in places with more fluoridated water, the S.C. Dental Association report said.

Fluoride, which occurs naturally, has been used since the mid-1940s to provide protection for teeth. Today, more than three-quarters of the U.S. population gets its water from systems that use fluoride, the American Dental Association reports.

Fluoride is particularly important for children, leading to a 25 percent drop in cavities, according to the American Dental Association.

Savings worth expense, effort

West Columbia’s Gradwell said it is hard to believe that any community would not put fluoride in its drinking water, particularly to help children avoid cavities.

Because it is not in her mobile home park’s water system, Gradwell makes sure the dentist puts fluoride on her young grandson’s teeth during each visit. Gradwell can’t say whether the absence of fluoride in her mobile home park’s water system will one day hurt her grandson, but it’s a worry.

“My grandson, he loves water,’’ she said. “He’ll take a whole bottle and down it. If I had fluoride in my drinking water, it would be a whole lot different. I’m hoping he doesn’t have problems.’’

Attempts to reach Peele’s Mobile Home Park, where Gradwell lives, were unsuccessful.

Not every community in South Carolina needs to add fluoride to its drinking water.

Some areas along the coast have too much naturally occurring fluoride in the groundwater they use for drinking. Mount Pleasant’s water system, for instance, treats the water to reduce naturally high fluoride levels to the proper levels.

Fluoride systems “are difficult for staff to operate,’’ said Clay Duffie, who runs the Mount Pleasant Waterworks. “That’s why a lot of small systems may choose not to do it.’’

But for dentist Bracey, the expense and effort to add fluoride is worth it.

Fluoride saves, on average, $38 a year in treatment costs for every dollar spent to fluoridate water, the S.C. Dental Association says.

“All dentists are going to back that up,’’ Bracey said. “The teeth absorb the fluoride and it needs to be replenished, besides just from toothpaste.’’

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Hundreds of small water systems are abandoning fluoride as a way to protect children’s teeth because they say they can’t afford it Courtesy Medical University of South Carolina

Findings: Fluoride often missing

• The government does not require fluoride in drinking water despite years of evidence that it protects children’s teeth.

• More than 300 S.C. water utilities, serving up to 317,000 people, don’t put fluoride in the water to protect people’s teeth from cavities. Most of the systems are small ones serving 235,000 people.

• Many of the water systems are in rural South Carolina. Twenty-one percent of children in rural areas of the state had untreated cavities, compared to 9 percent of children in urban areas, according to a 2012 state study.

• Nearly a third of the small utilities in South Carolina that don’t put fluoride in the water are in Richland and Lexington counties.

• Fluoridating water can cost utilities anywhere from $10,000 to more than $100,000 annually, depending on the utility’s size.

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Sammy Fretwell has covered the environment for more than 20 years at The State. He writes about an array of environmental subjects, including nature, climate change, energy, state environmental policy, nuclear waste and coastal development. Fretwell is a University of South Carolina graduate who grew up in Anderson County. Reach him at 803 771 8537.
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