Wednesday, January 10, 2001
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Posted on: Wednesday, January 10, 2001

Moloka'i health group pushing for fluoridation

By Christie Wilson
Advertiser Neighbor Island Editor

WAILUKU, Maui — Molokai’s health-care community is trying to do for residents of the Friendly Isle what the Legislature failed to do last year — fluoridate public water systems to fight rampant tooth decay.

Gov. Ben Cayetano has announced that his administration once again will push for statewide fluoridation during this year’s legislative session, but the Molokai Dental Health Coalition is not waiting to find out how that battle will turn out. It has asked the Maui County Board of Water Supply to approve fluoridation for the island’s 6,500 or so residents.

The coalition comprises Molokai General Hospital, the Molokai Health Foundation, the state Department of Health, and Na Puuwai, the island’s Native Hawaiian health-care agency. The fluoridation campaign has the support of Molokai’s three full-time dentists and other health-care professionals, but is likely to run into the same kind of strong opposition that doomed previous efforts to add fluoride to Hawaii’s drinking water systems.

Fluoridated water is available to 65 percent of the U.S. population. Most major U.S. cities have fluoridation. Las Vegas started last year, and San Diego and San Antonio are next.

With a 50-year history of fluoridation in the United States, supporters say there has been no credible evidence of health threats.

Critics dispute that. Many are uneasy with the idea of government tampering with public water supplies.

At a Maui County water board committee meeting yesterday in Wailuku, board member Jonathan Starr said fluoridation is no different than if police were to put the drug lithium, used to treat manic-depression, in drinking water to curb violence. Starr said he would not drink tap water if fluoride were introduced in the public supply.

Fellow board member Howard Nakamura was more concerned about the cost and whether public health issues should be of concern to the water board, whose chief purpose is to supply safe drinking water.

"You have your mission, and we have our mission," Nakamura told coalition representatives. "The question is whose mission is being furthered (by fluoridation) and who should pick up the tab for that."

Dr. Mark Greer, chief of the Health Department’s Dental Health Division, said the state is committed to paying the $145,000 first-year start-up cost for fluoridation on Molokai. Any more money would be up to the Legislature, but Greer said he hopes his department would be able to pay the $10,000 annual cost in subsequent years.

He said the ultimate saving to taxpayers would be in the millions, since it has been calculated that every $1 spent on fluoridation saves $80 in dental care costs.

Fluoridation would not be new on Molokai. In 1961-72, pineapple grower Libby-McNeil fluoridated the water system serving the West Molokai community of Maunaloa. Coalition representatives said an examination of Maunaloa residents’ dental records during that time shows a marked decline in tooth decay. Once fluoridation was stopped, the rate went up again.

Although Molokai’s water systems are operated by different entities — Maui County, Molokai Ranch, the Kaluakoi resort and the Department of Hawaiian Home Lands — county approval is seen as the linchpin to the coalition’s success.

Debra Mapel, a dental hygienist on Molokai for 23 years and coalition facilitator, told the water board that there is a dire need for better dental health on the economically depressed island.

A 1999 oral health assessment indicated that 35 percent of Molokai children had five or more decayed teeth, while 23 percent were free of tooth decay. Only Lanai had a worse showing.

By comparison, at Oahu military bases, where the water is fluoridated, 62 percent of the children were free of tooth decay, and only 20 percent had five or more decaying teeth.

Another study shows Molokai with the highest incidence of "baby-bottle tooth decay."

Most residents of the island consider dental care optional, Mapel said. Supplying the population with free fluoride supplements is not an answer, she said, because patient compliance is poor.

Using information supplied by a Molokai pharmacy, Mapel said that only 686 of the island’s 1,394 children aged 6 months to 13 years who should be taking a fluoride supplement have prescriptions for a supplement. Each prescription lasts only a few months, and only 39 percent are refilled, Mapel said.

The dental health coalition will hold a public forum on fluoridation sometime next month.

Water board members expressed a desire to conduct their own public hearing on Molokai before considering the coalition’s request.

State health officials said yesterday that they tentatively plan to use $5 million from the state settlement with tobacco manufacturers to pay for fluoridation of water treatment systems that serve more than 5,000 people. That plan is contingent on lawmakers’ approval of fluoridation of the water supply, however. Lawmakers rejected fluoridation last year, but health officials said they will propose it again this year.

Advertiser Staff Writer Kevin Dayton contributed to this report.

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