Convincing a majority of lawmakers of the benefits of requiring fluoride in New Jersey's public water supply has been like pulling teeth for years in the New Jersey legislature.

The long-hoped for measure by dentists has consistently been opposed by some environmentalists and water companies. But on Monday, the Assembly's health committee took another shot at moving the bill.

"Hope springs eternal," said Assemblyman Herb Conaway (D-Burlington), a medical doctor and chairman of the heath committee, which cleared a bill similar to legislation that failed to make it through the last session.

Only 13 percent of New Jerseyans drink fluoridated water, according to data from the Centers for Disease Control and Prevention (CDC), placing New Jersey next to the bottom nationwide.

Dentists say access to the teeth-strengthening fluoride would drastically reduce cavities, especially in the New Jersey's poorer cities. "We see an awful lot of dental disease in children," said Dr. Nanci Tofsky, professor and interim chair of the Department of Pediatric Dentistry at UMDNJ-New Jersey Dental School.

But the bill has its critics -- water companies and environmentalists who cite its impact on the environment, potentially harmful health effects, and the cost of installing fluoridation equipment for opposing the measure.

Jeff Tittel, director of the New Jersey chapter of the Sierra Club, said his organization is not opposed to water fluoridation, but he urged the committee to ban the use of industrial-grade fluoride, which may contain heavy metals such as mercury, cadmium and lead.

"Any grade of fluoride that is not industrial will suffice," he said. "Fluoride in our water can be healthy, but not if it also contains toxic chemicals. The legislature's job should be removing toxins, not adding them."

New Jersey has been talking about fluoridation "for the past 50 years," said Arnold H. Rosenheck, assistant dean of the New Jersey Dental School.

"We're going to keep plugging away because it's too important to let it be," Conaway said.

Conaway said he is encouraged to see bipartisan support for the water fluoridation bill, A-1811. It is cosponsored by health committee member Assemblywoman Nancy F. Munoz (R-Union, Morris and Somerset), who is a nurse. "The aim of community water fluoridation is to keep the tooth enamel strong and reduce decay," she said. "Fluoridating our water is a cost-effective and efficient way to help people avoid the physical and financial pain of dealing with dental problems."

The Assembly health committee heard from both sides of the issue on Monday before clearing the bill for consideration by the full Assembly.

Dr. Barbara Rich, a dentist in Cherry Hill and president of the New Jersey Dental Association, told the committee that fluoridation "is the least expensive, most effective way to reduce dental disease, which is the most prevalent childhood disease in the country -- five times more prevalent than asthma."

The pediatric clinic at UMDNJ in Newark, for example, serves about 100 children each day. Tofsky estimated about half the children seen at the clinic have dental problems that would have been alleviated with fluoride.

"We see children as young as two getting cavities," Tofsky said. If children don't have access to fluoridated water and have not been getting fluoride through vitamins, "their teeth get decayed faster and decay goes deeper into the tooth and leads to infection."

The chance of tooth decay is reduced 30 percent to 40 percent for children who receive supplemental fluoride, either in their drinking water or a daily vitamin, Tofsky said.

But Karen Alexander, president of the New Jersey Utilities Association, argued that "the consumption of fluoride for medical purposes, in this instance to prevent tooth decay, is a decision that should not be imposed upon people who may not want it or may be susceptible to potential adverse health effects.

"There are numerous other means for those who choose to use fluoride for dental hygiene to do so without imposing it on those who care not to make the same choice," she said.

The cost associated with adding fluoride is prohibitive, Alexander said. "These costs are ultimately borne by ratepayers, the water utilities' customers, many of whom are already facing considerable difficulties in the current economic climate."

Water companies say the upfront costs to purchase and install equipment range from $400,000 to over $64 million, Alexander said. "These costs include system design, state Department of Environmental Protection permits, local zoning and planning board approvals, legal expenses, local building permits, construction, and instrumentation and control. Operating and maintenance expenses would be additive."

Conaway, the committee's chairman, countered that the costs to New Jersey residents would be minimum. "Our estimates are that the cost is less than $1 a month for the average consumer of water who is getting it from the water system," he said.

The cost will be dwarfed by the savings they will get in less dental costs, Conaway said. And improved dental health would save the state millions of dollar its Medicaid program, which provides dental coverage to more than 1 million people in New Jersey.

At the pediatric dental clinic in Newark, dentists fill cavities and sometimes have to extract teeth. Last week, a child was referred for root canal. "Sometimes we can't save a two-year-old's tooth. The cavity sometimes is so extensive that the tooth is not restorable," Tofsky said. It is a problem when children lose baby teeth, which are needed to eat and drink properly, to speak properly and to have a healthy mouth.

"There is no doubt that children living in the inner cities would benefit from fluoride, but all children would benefit from fluoride," Tofsky said. Parents can give children vitamins with fluoride, but that does not always happen. "That is the benefit of fluoridated water: You don't have to think about. It's there and you drink water every day. I think that the children of New Jersey would benefit greatly from fluoride in the water."

Foes of fluoridation argue that it can actually cause damage to the teeth. According to the U.S. Department of Health and Human Services, overconsumption of fluoridate during the tooth forming years, ages 8 and younger, appears in the U.S. in a mild form of dental fluorosis, "barely visible lacy white markings or spots on the enamel. The severe form of dental fluorosis, with staining and pitting of the tooth surface, is rare in the United States."

In January 2011, the federal health and environmental protection agencies proposed setting the recommended level of fluoride in drinking water at the lowest end of the current optimal range for preventing tooth decay. At the same time, the EPA initiated a review of the maximum amount of fluoride allowed in drinking water. The Department of Health and Human Services proposed that 0.7 milligrams of fluoride per liter of water should replace the current recommended range of 0.7 to 1.2 milligrams.

"Americans have access to more sources of fluoride than they did when water fluoridation was first introduced in the United States in the 1940s," the agencies said. "Water is now one of several sources of fluoride. Other common sources include dental products such as toothpaste and mouth rinses, prescription fluoride supplements, and fluoride applied by dental professionals."

Speaking against the bill was Ron Farr, principal environmental scientist of the North Jersey District Water Supply Commission, which he said is one of the state's largest public water utilities, serving 2.5 million New Jerseyans.

"The commission recognizes the impact poor dental health has in the day-to-day lives particularly of the poor and underprivileged children of this state," Farr said. "The commission has pledged in the past and continues to pledge support and a willingness to work with the legislature and the professional dental community to help address and correct this problem in the most effective manner possible. Many factors affect dental health including good oral hygiene, regular dental care, and the effective use of fluoride via topical application."

Eric Elmore, spokesman for the New Jersey Dental Association, said typically several towns are served by the same water distribution network, and all have to agree for fluoridation to occur. That is why advocates are looking to the legislature to mandate public water fluoridation, which would be overseen by the Department of Environmental Protection.