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A 2006 report by the National Academy of Science has fueled opposition to water fluoridation. The academy's National Research Council reviewed the latest science and concluded the Environmental Protection Agency's current standard of toxicity, 4 milligrams per liter, is not adequate to protect human health. This was based on evidence that fluoride at that level can make teeth and bones weaker over time, and cause severe teeth problems in children.

Dr. Alan Gross is an orthopedic surgeon in Juneau who is against fluoridation.

"The National Academy of Science is the Supreme Court of science. I don't believe the pro-fluoride group has thoroughly evaluated the most recent study by the NRC," Gross said. "I have concerns about its effects on bone strength and, as fluoride is cumulative in bones, I believe it puts people at higher risk for hip fracture."

Dr. Carolyn Brown, an obstetrician and head of the pro-fluoridation group Citizens Promoting Dental Health, said the recent report is irrelevant to the debate because it did not examine the benefits or risks of fluoride when it's added in optimal amounts to community water supplies. She said there is a safe level for fluoride, just as there is for chlorine.

"Too much of anything will kill you. They (the NRC) were setting up standards for an entirely different reason than optimal fluoridation of community water. One needs to carefully read what it says," Brown said.

Fluoride is present in most water supplies naturally. When there is too much, some cities have to remove fluoride so that it meets the EPA standard. The EPA is currently looking at whether to lower that standard from 4 to 2 milligrams per liter.

Because of the 2006 NRC report, the American Dental Association has changed its guidelines on how much fluoride infants up to 1 year old should be exposed to, recommending fluoride-free water be used for infant formulas.

The ADA still supports fluoridation as a "safe, beneficial and cost effective way to prevent tooth decay," according to its Web site.

Pro-fluoridation groups point to the continued support of fluoridation by authoritative bodies such as the ADA, American Medical Association, Centers for Disease Control and U.S. Public Health Service. They point to studies that show a decrease in tooth decay of 20 to 40 percent in communities that fluoridate water, and substantial savings in dental treatment costs.

Those who are against fluoride in Juneau have used Hardy Limeback and the 2006 NRC study as their main authority. Limeback is a dentist and scientist who sat on the 2006 NRC panel that reviewed the evidence on fluoride toxicity. Limeback says fluoride is harmful in any amount when swallowed, but not harmful when used in toothpaste.

While the ADA has issued short responses to the 2006 study, it continues to provide a 2005 publication on fluoride, called "Fluoridation Facts," as its main answer to safety questions. That publication refers to an outdated 1993 study by the NRC, which found the EPA's toxicity standard was safe.

The 2006 NRC report makes clear new evidence has come to light since its own 1993 report:

"A 1993 report from the National Research Council had concluded that the EPA standard of 4mg/L as an appropriate interim standard until more research could be conducted. However, following a comprehensive review of the research conducted since 1993, this report concludes the EPA standard is not protective of health."

Mary Alice McKeen is an attorney, administrative judge and head of the anti-fluoridation group Juneau Citizens for Safe Water. She says it's "ridiculous" for anyone to claim the new report is irrelevant.

"The silence from the dental community on the NRC report is deafening. I think it is irresponsible for the ADA to continue to push that booklet when, since 2006, there has been this major review of fluoride toxicity. The reason they haven't updated the booklet is they don't know how to respond," McKeen said.

Fluoridation advocates say not adding fluoride to water will put the most disadvantaged at risk - those who cannot afford regular dental care.

McKeen hopes the community will put fluoride aside and directly address any problem with children not having access to dental care. She said Native children have access to free dental care through SEARHC, and poor families have access through state programs. She also worries families may not know they must not feed their infants fluoridated water.

Both sides agree fluoridated water should not be fed to infants.

Juneau Assembly member Bob Doll, who is pro-fluoridation, said people will make a choice at the polls based on whether they accept the advice of authorities and government, adding "my authorities are bigger and more numerous than the others' authorities.

"The best evidence that I can find comes from those folks that are paid to do this kind of evaluation," he said, referring to the ADA, CDC, AMA and other organizations that support fluoridation.