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Dental Public Health Activities: Descriptive Summaries

Community Water Fluoridation in Manchester, New Hampshire

Practice Number: 32004
Submitted By: Manchester Health Department, New Hampshire
Submission Date: May 2002
Last Reviewed: January 2013
Last Updated: January 2013
Best Practice Approach Example Community Water Fluoridation in Manchester, New Hampshire

In April 1999, the Healthy Manchester Leadership Council (HMLC), a community collaborative representing 20 health and human services organizations in Manchester, published a special report, “The Oral Health Status of the City of Manchester, New Hampshire,” which provided the motivation and impetus for taking community-wide action to improve oral health in Manchester.  In preparation for the campaign, the State Department of Health and Human Services, the New Hampshire Attorney General’s Office as well as the Department of Environmental Services provided preliminary groundwork with regard to state legislation.  Since New Hampshire Law requires a referendum prior to initiating community water fluoridation, the Manchester City Clerk’s Office and City Solicitor’s Office were also involved in providing legal guidance.  The municipal election of November 2, 1999 was determined to be the next opportunity to attempt this referendum. The process involved two distinct phases, first was the obtaining of the required number of signatures from registered Manchester voters (10%) to place the question on the November 2nd ballot, and secondly to assure there would be a majority of voters approving the fluoridation question on November 2nd.  The signature collection phase and “kick off” for our “Smiles for the Future” campaign began on May 11, 1999.  Petitions were distributed to provider offices, to community social service agencies, and at community events.  Petitions and fluoridation information were sent to thousands of homes of registered voters and a petition was also placed in the newspaper for people to sign and return.  A HMLC representative made presentations to community service clubs and PTA groups and conducted media interviews.  The required signatures were obtained by the deadline.  The Board of Mayor and Alderman held a public hearing prior to placing the question on the official ballot. With only five weeks of campaigning and a limited budget, our strategy was to purchase ads in the local newspaper.  Post cards were mailed to residents who had signed petitions to remind them to vote on November 2nd.  Against all odds and predictions, the fluoridation question was approved by the voters of Manchester by a margin of approximately 650 votes, or less than 1% of the total vote.  The total campaign was accomplished for approximately $15,000 (includes newspaper advertisements and some printing) with in-kind donations of stamps, envelopes, posters, post cards, and pamphlets.  Delta Dental and the Manchester Dental Society also provided their own advertisements.  Since the Manchester Water Department sells fluoridated water to portions of six surrounding communities that were not part of the fluoridation referendum, a court case was brought by an individual from one receiver town to protest their inability to participate in the fluoridation referendum.  The judge found in favor of the right of all towns that purchase fluoridated water to participate in a second referendum. In a second vote an even larger percent of the voters than before supported the addition of fluoride to the public water supply for Manchester and six surrounding towns. Fluoridation of the Manchester’s water began on December 19, 2000 and continues as of December 2012.

Contact Person(s) for Inquiries:

Nancy Martin, RDH, MS, Oral Health Program, New Hampshire Department of Health and Human Services, 29 Hazen Drive, Suite 302, Concord, NH 03301, Phone: 603-271-4535, Fax: 603-271-4506, Email:

Susan G. Myers, RN, MEd, Community Health Supervisor, Manchester Health Department, 1528 Elm Street, Manchester, NH 03101, Phone: 603-624-6466 Ext. 335, Fax: 603-628-6004, Email: