Building Effective Statewide Teams for

Fluoridation

Water Operators: Untapped Allies Itasca, IL

March 21, 2018Gina Sharps MPH, RDH

Johnny Johnson, Jr., DMD. MS

• Recognize The Roles/Opportunities/Limitations Of Water Operators As It Relates To Community Water Fluoridation (CWF)

• Explore Strategies To Engage And Empower Water Operators

• Identify Resources Readily Available To Educate Water Operators On The Importance Of CWF

Grounding Statement

• “We must recognize the water operator as being part of the professional team…

• He/she should be recognized, because they do more to prevent decay than all the dental professionals in a community can do in their lifetimes.”

• Proficient in the operation and maintenance of all fluoridation equipment

• Proficient in the proper handling of fluoridation additives and associated safety requirements

• Provide advice to their governing bodies regarding the fluoridation process

What is the primary role of Water Operators as it relates to CWF?

• Potential lack of correct knowledge regarding the safety and effectiveness of CWF

• Personal concerns regarding handling the additives

• Lack of budgetary funds for CWF• Water Managers and staff may favorably support

CWF, but the CWF decision-makers do not

What are the limitations that Water Operators experience related to CWF?

• Engage water operators in discussion about CWF and the huge public health benefits it provides

• Educate the public regarding how CWF is performed

• Dispel (to the public) false rumors about safety and the treatment process

What are the opportunities for Water Operators as it relates to CWF?

WWW.ASTDD.ORG

Strategies to Engage and Empower

• Leverage opportunities utilizing the Fluoridation Awards

• Showcase partnerships with state oral health coalitions, legislators, state oral health programs

Midwest City, OK50 years of Fluoridation, awarded in 2012

Muscatine Power & Water, Iowa50 years of Fluoridation, awarded in 2017

Cudahy Water Utility, WisconsinRogersville Water Department, Tennessee50 years of Fluoridation, awarded in 2017

Strategies to Engage and Empower

• Collaboration with WV Department of Health and Human Resources, Division of Environmental Engineering

• 2016-2017, 2 PWS=upgrade, 1 PWS=initiate

• 2017-2018=2 PWS=upgrade

Strategies to Engage and Empower

Town of Gilbert, WVPopulation served = 8,114

• An international, nonprofit, scientific and educational society dedicated to providing total water solutions assuring the effective management of water

• The largest organization of water supply professional in the world

• www.awwa.org

Strategies to Engage and Empower

• A non-profit organization dedicated to training, supporting, and promoting the water and wastewater professionals that serve small communities across the United States.

• www.nrwa.org

Policy Statement on CWF

https://www.awwa.org/about-us/policy-statements/policy-statement/articleid/202/fluoridation-of-public-water-supplies.aspx

Strategies to Engage and Empower

• States belong to a AWWA section• Explore opportunities to either

present or participate as a vendor

• Potential contacts can include engineers/contracts, regional environmental engineers, local water operators

• Excellent opportunity for partnerships with state oral health coalitions

Strategies to Engage and Empower

Strategies to Engage and Empower, cont’d

Strategies to Engage and Empower

Strategies to Engage and Empower• Environmental scan

• Determine readiness of water system to either upgrade/initiate CWF

• Determine a need for CE as identified by water system

• Constructed by WV Oral Health Coalition, WV DHHR Division of Environmental Engineering

• Reviewed by American Fluoridation Society

• $ to mimic NACCHO/CDC funding opportunity for water systems to upgrade/initiate CWF

• Only available in the foundation catchment area=8 counties

Strategies to Engage and Empower

Strategies to Engage and Empower

• Engage and provide education to local PSDs on the importance of CWF

• Communication Packet created by Water Operators for Water Operators

• Hand delivered by community partners

• Only available in the foundation catchment area=6 counties

• Water Operator Licensure• Class 1, Class 2, Chief Water Operator

Examinations• Modifying Question Bank

• A water plant uses ## gallons of sodium fluoride solution in treating ##MGD of water. Natural fluoride ion is 0. ##mg/L What is the calculated dosage?

• The SMCL (Secondary Maximum Contaminant Level) and MCL (Maximum Contaminant Level) for fluoride in drinking water is:

• Ingestion of fluoride in drinking water over 1.5ppm can cause:

Strategies to Engage and Empower

• Policy Collaboration to strengthen existing CWF legislation• State-local level leadership

Strategies to Engage and Empower

8.2. Public water systems that plan to make long term changes in the method being used to artificially adjust fluoride levels, such as a change in the chemical composition or the dosage rate, shall notify the Commissioner prior to implementing the proposed change. The commissioner shall approve the change in writing before the public water system may begin implementation of the changes.

Fluoridation decisionsWho is involved

• City councils• Water utility boards• County commissions

Fluoride science meets political science

Reaching out to decision-makers and staff

Engage the local decision-makers:

Encourage them to be guided by the credible evidence

Recognize how their constituents’ concerns shape their thinking

Explore whether they have a personal “dog in the fight”

Invite their questions

Staff (Elected officials often seek their input):

City manager/County administrator

Water utility manager/director

Don’t wait. At the earliest signs .. . Call or email (individually) your local CWF decision-makers to

request a meeting to discuss dental health — and take a local health dept. official to join you

Send a “thank you” email afterward (to their public email address)• Briefly summarize the discussion that you had• Include the position on CWF that he/she declared• Share any data or info that you promised to follow up with

Meet with all candidates seeking state/local office who will be in a CWF decision-making position and ask where they stand

Keep and print all of the emails that you send or share with these officials or candidates

Wisdom from a Florida county commissioner:

Public officials have a responsibility to listen to their constituents. We also have a duty to not allow false fear to drive public health decisions. We should direct our constituents to reputablewebsites . . . We shouldn’t let “guess what I read on the internet” be the reason that we abandon a proven, safe practice like water fluoridation.

“

”Karen Williams Seel (R)Board of Commissioners, Pinellas County, FL

(Source: Karen Williams Seel, “Fluoridation: Elected officials have a critical duty,” Teeth Matter, the blog of the Children’s Dental Health Project, July 17, 2014.)

If you don’t show up, someone else will

• You are the ideal person to advise public officials

• You care deeply about the health and wellness of your community

• You must step forward or someone else becomes “the expert” by default

• I did it — and so can you!

Ignoring the evidence can have consequences

Oct. 4, 2011: CWF was voted out by 4-3

Pinellas County, FL County Commission

On Nov. 27, 2012, the County Commissioners voted to restore fluoridation by a 6-1 vote.

Engaging the news media Know the media landscape in your county or community:

• Newspaper reporters and editors

• TV and radio show hosts• Bloggers• Online bulletin boards

Reporters & Editors: Reach out to them and present yourself as a resource who can answer questions and clarify issues

Seeking your newspaper’s editorial support

Local water personnel:Establish a relationship

Get to know your local water personnel

Tour your local water plant

Compliment the staff on the facility’s organization and cleanliness

Thank them for providing safe drinking water to their residents

Thank them for providing fluoride to help prevent cavities

Let them know the impact they are making

Let them know that they prevent more cavities than all of the dental professionals in their area could do in a lifetime by fluoridating the water

Why water personnel play a key role

• They handle a job that most local elected officials do not fully understand

• Elected officials tend to defer to water operators and managers—especially when they hear no countervailing facts

Claim: Fluoridation causes pipes to corrode

FALSE

“The concern that using fluorosilicate additives to fluoridate drinking water causes water system pipes to corrode is not supported by science.”(Source: “Community Water Fluoridation: Drinking Water Pipe Systems,” Centers for Disease Control and Prevention, updated July 10, 2015.)

Visit the AmericanFluoridationSociety.org

• Find helpful one-pagers through the AFS website

• Find info to “debunk” the claims that critics are circulating in your state or community

A Critical and Immediate Request:

Pull your Water Quality Annual Report Today!!

• Check the fluoride levels. The Range detected for 2016 was from likely background levels of 0.06ppm up to 0.79ppm.

• The Highest Ave. Level Detected was 0.62. This requires investigation. What was going on? Repairs during which CWF had to be stopped? Stopped on purpose?

• The explanation is likely credible, but the DOH fluoridation officer, Dr. Fairrow, would have access to monthly reports and other data. Let her know immediately. This could be a problem area.

Nashville, TN, 2017

https://www.nashville.gov/Portals/0/SiteContent/WaterServices/docs/reports/2017%20CCR.pdf

Fluoridation and Fluoride Web pageWWW.ASTDD.ORG

Resources

Resources

Resources

Infocard

American Fluoridation Society Web page

www.AmericanFluoridationSociety.Org

Resources

• AAP Campaign for Dental Health

• American Water Works Association

• ASTDD Fluorides Committee

• American Fluoridation Society

• Centers for Disease Control and Prevention

• American Dental Association

ResourcesNational State Local

◦ Division of Environmental Engineering

◦ Bureau for Health◦ State Chapters of the

ADHA, ADA, AAP, NRWA

◦ YOU

• Gina Sharps, MPH, RDH, CTTSOral Health Educator

Marshall Universitysharpsg@marshall.edu

304.276.0572

Johnny Johnson, Jr., DMD,MSPediatric Dentist

Diplomate American Board of Pediatric DentistryPresident, American Fluoridation Society

Johnny@AmericanFluoridationSociety.comc: 727.409.1770

Web: www.AmericanFluoridationSociety.orgTwitter: @AFS_Fluoride