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This is a change of position for me, because I always assumed fluoridation is safe. But I no longer believe this.

Here's the red flag: If Juneau does not fluoridate, could people get over-the-counter systemic (swallowable) fluoride from their pharmacist instead?

The answer is no.

Local pharmacies (as well as the Mayo Clinic and the local Public Health Service) require a doctor's prescription to dispense fluoride in a swallowable form. Why?

According to manufacturers of ingestible fluorides, you should tell your doctor if you have any of these conditions:

"Pregnant, trying to get pregnant, breast-feeding, have arthritic joints, stomach or intestinal disease, kidney disease, stained, mottled, or pitted teeth, or an unusual or allergic reaction to fluoride, tartrazine, other medicines, foods, dyes, or preservatives."

Presumably, if you have any of these conditions, your doctor would inform you of the potential benefit and possible dangers of swallowing fluoride, before writing you a prescription.

If we fluoridate, none of the people in this warning can drink Juneau's water, without ingesting fluoride.

These prescriptions contain the same active ingredient proposed for fluoridating Juneau's water: sodium fluoride (NaF). The recommended dosage in these tablets is actually less than, or equal to, the amount of fluoride we are being asked to add to our water.

At 0.25 mg, one of these prescription tablets is one-fourth as potent as what we are voting for in Proposition 2. If Juneau fluoridates at 1 part per million, one cup of Juneau's water will have about the same amount of fluoride as one of these tablets.

To be clear on this point, according to this manufacturer, you should not take one of their tablets, the equivalent of drinking 250 ml of Juneau's fluoridated water (about 1 cup), without a doctor's prescription.

But the warnings are even stronger than that: Some manufacturers and the American Academy of Pediatrics do not recommend ingestible fluoride, at all, for infants up to 6 months. Your doctor would not prescribe it, and if you asked for it anyway, and gave it to your infant, it would be against medical advice.

If we vote to fluoridate, we will over-ride the requirement for a doctor's prescription, force fluoridated water on Juneau's infants, and ignore any other at-risk patient's right to informed consent.

If we don't fluoridate, would any doctor advocating for fluoridation write a daily quadruple prescription of these fluoride tablets (1 mg), for infants, children, and adults? I doubt it.

If not, they should not ask us to vote for fluoridation.

But is swallowing fluoride dangerous?

Read your toothpaste tube. Mine, in essence, says: "Do not swallow, if you do, seek immediate medical help." That's if you swallow a lot, all at once.

For the possible long-term effects, according to "Fluoride in Drinking Water: A Scientific Review of EPA's Standards," published by the National Research Council in 2006, about 50 percent of the fluoride you drink passes through your system. The other 50 percent stays with you, mostly in your bones, and the rest is in your soft tissues, blood, and presumably in your tooth enamel.

Studies have shown the uptake rate of fluoride into bones is four times its clearance rate, and estimate 20 years as the half-life for fluoride in bones. Using a standard pharmokinetic model, with a half-life of 20 years, and a 50 percent passage rate, for each gallon of fluoridated water you drink when you are 6, one cup's worth of its fluoride will still be in your bones at age 66.

It accumulates, but is it bad for you? I don't know, but more and more research indicates it may be horrible. For a short list, accumulated ingested fluoride causes fluorosis, may cause bone cancer, increase the risk of hip fractures, be implicated in Alzheimer's and compromise your thyroid and kidney. For me, these potential life-long health risks far outweigh any possible benefit for short-term cavity reduction.

Please don't swallow fluoride. And please vote no to fluoridation.

• Bruce Simonson is a Juneau resident.