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Water fluoridation in Arkansas

July 1, 2011
In last month's column we discussed the proposed recommendations for community water fluoridation.

by Christine Nathe, RDH, MS
[email protected]

In last month's column we discussed the proposed recommendations for community water fluoridation. So when I received big news from Arkansas, I thought it would be a great column to follow last month's discussion. House Bill 359 was recently signed by the Arkansas governor, which requires that water systems serving 5,000 or more people must guarantee access to fluoridated water for their customers. Evidently, the bill passed both the Arkansas Senate and House.

Governor Mike Beebe (seated) signs community water fluoridation legislation in the presence of various public officials, including Dr. Lynn Douglas Mouden, the state's dental director (standing directly behind the governor, wearing a red jacket).

I found out more about this great achievement, and a few others, from renowned dental public health leader, Lynn Douglas Mouden, DDS, MPH. Dr. Mouden is also the Director of Oral Health in Arkansas.

Can you please tell us about your legislative successes this past session?

In the 2010 report from the Pew Center on the States entitled "The Cost of Delay," Arkansas received a grade of F in oral health policy. While Arkansas dental and public health leaders had misgivings about the way the grading was done, the report nevertheless got the attention of advocates and legislators. The Arkansas Department of Health Office of Oral Health convened an Oral Health Policy Tool workshop in August of 2010. Three of the outcome policy recommendations from the workshop were fluoridation for Arkansas water systems, creation of a "public health hygienist" category, and rules to allow physicians and nurses to apply fluoride varnish.

State Senator David Johnson of Little Rock took on these issues in his legislative package. We worked closely with the Arkansas Oral Health Coalition, and the leadership of both the Arkansas State Dental Hygienists' Association and the Arkansas State Dental Association. Senator Johnson filed three separate bills for oral health policy change.

Senate Bill 42 provides for creating a "collaborative practice" category for dental hygienists. Dental hygienists certified by the dental board will be allowed to perform prophies, topical fluoride application, and dental sealant placement in public settings without a patient having first been seen by the dentist. The public settings include community health centers, local health units, schools, free clinics, Head Start, and long-term care facilities.

Senate Bill 43 allows physicians and nurses to apply fluoride varnish for their patients. Before its passage, the state dental practice act prohibited anyone but a dentist or dental hygienist from performing preventive dental procedures. Physicians and nurses who want to provide fluoride varnish must complete training on patient risk assessment and varnish application.

Senate Bill 359 guarantees access to fluoridated water for customers on Arkansas water systems that serve 5,000 or more people. This bill affects 32 water systems and 640,000 Arkansans.

In your opinion, what were the key components of your recent success?

The key to passage of the legislation lay in the tremendous support from all areas of dentistry and medicine. Having the support of dentistry, dental hygiene, and medicine made passage of the hygiene and varnish bills almost a certainty. Both bills passed both houses with hardly a dissenting comment.

The fluoridation bill was the culmination of 11 years of work and advocacy on the part of the Office of Oral Health and the Arkansas Oral Health Coalition. The keys to success were the incredible support of the Delta Dental of Arkansas Foundation and the Pew Center on the States' Oral Health Initiative. Early on, the Delta Dental foundation pledged at least $500,000 to purchase and install fluoridation equipment for the 32 affected systems. That pledge removed any thought that the legislation was an unfunded mandate.

Along with that pledge, Pew did two things that specifically helped fluoridation. First, Pew commissioned a public opinion poll in Arkansas that showed overwhelming support for fluoridation. Secondly, Pew provided funding to hire contract lobbyists in Little Rock to help move the legislation. Without the help of Delta Dental and Pew, Arkansas would not have made the strides in legislation that have become the hallmarks of oral health policy.

How can other states build on Arkansas' success?

First of all, they should never give up. Perseverance pays off when the message of oral health's importance remains in the public domain. Secondly, they should build and maintain coalitions that go far beyond the usual players. Dental hygiene and dentistry cannot win these battles alone. Finally, they should support the dental public health leaders in every state – those individuals and their programs that promote population-based prevention.

This is certainly exciting news. Also, a great message is inherent in this success, and that is how collaboration works to our advantage – when working to promote the oral health of the public!

Christine Nathe, RDH, MS, is a professor and graduate program director at the University of New Mexico, Division of Dental Hygiene, in Albuquerque, N.M. She is also the author of "Dental Public Health Research" (, which is in its third edition with Prentice Hall. She can be reached at [email protected] or (505) 272-8147.

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