Fluoride will remain in Hamilton's water supply at least until this fall.

Hamilton's Board of Health agreed last week to investigate alternative methods and costs of delivering fluoridation to residents.

At least one councillor suggested Hamilton should hold a referendum on the issue in the 2010 municipal election.

"I'm much more comfortable with a targeted approach so people are actually getting (fluoridation)," said Ward 1 councillor Brian McHattie.

In response to a resident's presentation, Hamilton mountain councillor Terry Whitehead said that only one per cent of fluoridation in the water supply gets to the public. The rest of the water flows into swimming pools, washing machines, baths, golf courses and lawn watering.

"There is no control of the dosage," said Mr. Whitehead. "We are using water for a lot of other things."

Dr. Elizabeth Richardson, the city's medical officer of health, said it will take until the fall for public health officials to provide the data.

For over three hours, the board heard scientific information on the detriments and benefits of fluoridating drinking water.

Opponents of fluoridated water argue it provides minimal benefits. Plus, the high levels of fluoride, they argued, could create health issues including diabetes, kidney problems, or dental fluorosis (white spots on teeth).

Carole Clinch, research co-ordinator for the People for Safe Drinking Water, said that fluoride is most beneficial when applied topically. She said there is no need for fluoride to be ingested.

Peter Van Caulart, director of training for the Environmental Training Institute, told board members there is a direct link between children who live under the poverty line and tooth decay.

Opponents argued studies suggested children living in poverty in a municipality that provides fluoridation have a higher rate of tooth decay.

Adding fluoride to the water system, he said, means pouring hydrofluorosilicic acid, and trace amounts of lead, arsenic and cadmium into the city's drinking water.

Opponents have further argued that fluoride, which is a mineral, is more associated with being a by-product of industrial waste, than a beneficial product for the public.

"Having a by-product of industrial waste in the water system is instinctively bad for me," said Flamborough councillor Margaret McCarthy. "It goes back to all the tobacco propaganda."

But Dr. Peter Wiebe, manager of the city's dental programs, said fluoridated water is the most cost effective way to protect people's teeth.

Targeted programs, he said, such as topical applications at schools will be more expensive and not very effective.

He pointed out the estimated annual budget for fluoridation is about $350,000 per year. But if it was discontinued, he argued, providing a clinic for fluoridation would cost half a million dollars, while adding a community bus would cost $250,000 in operating costs.

Public works general manager Scott Stewart said a decision needs to be made soon to allow city staff to either upgrade the fluoridation equipment or not. He said the cost would be about $1.2 million.

Mr. Wiebe said the amount of lead and arsenic in Hamilton's water supply is a small amount - between 0.00002 mg/l and 0.00003 mg/l.

Hamilton's public health officials brought in officials from the Health Canada office of the chief dental officer in support of fluoridation in the drinking water.

Hamilton maintains a fluoride level of between 0.5 to 0.8 parts per million in the city's water supply. Although Dr. Wiebe said the amount is a decrease from 1999 when it was 1 to 1.2 parts per million in response to high levels of "incidents of mild fluorosis."

Hamilton began putting fluoride into its water in starting in 1966 after holding a referendum.

Mountain councillor Tom Jackson suggested to finally decide the issue, it may have to be left up to the public in a referendum in 2010.

Waterloo Region is already putting the issue before the electorate in 2010.

"I'm not adverse to a referendum," said Mr. Jackson. "It may be a prudent option, given the importance of the issue."

In Ontario, about 70 per cent of the population, or about 8.7 million people drink fluoride water. About 45 per cent of the Canadian population has access to fluoridated water.

Worldwide about 405 million people drink tap water containing fluoride.

Fluoride has been supported by the Canadian Dental Association, and the Canadian Medical Association. The Centre for Disease Control and Prevention in Atlanta considers fluoridation of water "one of the greatest achievements in public health in the 20th century."

Hamilton has become the latest municipality to feel the effects of community groups opposed to fluoridation.

The Middlesex-London Board of Health last year approved a motion to evaluate the data on fluoridation and urged the provincial government to create a fluoridation office.

Hamilton's board this week supported establishing a fluoridation office.

Welland and Thorold in the Niagara Region last year were opposed to restoring fluoride in their water system.