Based on 2018-2022 dental equity data, Guerneville has the highest rate of preventable oral health emergencies in Sonoma County. As a practicing dentist and dental director of a clinic in Guerneville, I witness this reality first-hand and know that negative perceptions of tap water quality can lead many residents to prefer bottled water and sugar-sweetened beverages (SSBs). This not only increases their risks of obesity, diabetes, and dental decay, but also adds unnecessary costs for those on limited or fixed incomes.

To better understand community perceptions of water sources, I partnered with the Sonoma County Department of Health Services’ Oral Health, Healthy Eating Active Living, and Lead Prevention teams, and UCSF Dental Public Health Resident, Dr. Lauren Gritzer, to conduct an initial survey of residents in Guerneville. Among 141 respondents, 60% reported a high level of distrust of their tap water being safe to drink. While local tap water meets safety standards, negative perceptions appear to be driving Guerneville residents toward more expensive and less healthy bottled alternatives, perceived as safer and more palatable. Of our respondents 52% never or rarely consumed tap water and 53% consumed bottled water every day.

Research (1) (2) has shown that improving perceptions of tap water quality and promoting its consumption can significantly reduce reliance on bottled water and sugar-sweetened beverages. This shift not only supports public health by reducing the prevalence of obesity, diabetes, dental decay and other chronic diseases that are associated with sugar-sweetened beverage consumption, but also promotes environmental sustainability by decreasing plastic waste. Bottle material affects not only recyclability but also beverage safety; beverages bottled in plastics can be contaminated with suspended plastics and may also be subject to fungal or bacterial contamination from ingredients, processing equipment, and/or the containers themselves.

Considering this research, I partnered with the Sonoma County Department of Health Services and community-based organizations to work toward an upstream solution to address sugar-related chronic diseases and plastic waste through the strategic installation of filtered water refill stations in high foot traffic areas. By collaborating with West County Health Centers, Sonoma County Department of Health Services, Zero Waste Sonoma, Sonoma County Transit, and with the support of 5th District Supervisor Lynda Hopkins, we successfully installed a filtered water refill station by the Town Square of Guerneville, California.

The Town Square was an ideal location where local students frequently meet to go to school and return home. We anticipated that the availability of free refreshing water would give students a healthier hydration alternative before and after their school day. This location was also accessible to our unhoused population, many of whom are patients of my dental clinic, and who had voiced their concerns about not having a reliable place to access water at the end of the day when small businesses are closed.

The installation of this refill station was an important first step to addressing my patients’ chronic illnesses. It wasn’t enough to tell them to avoid sugar-sweetened beverages; we had to make sure they had easy access to an alternative. As a dentist, I believe our responsibility stretches beyond the clinic doors and into the community.

I am continuing to work with collaborators to explore additional sites where the availability of fresh, clean, attractive water will improve the health of our community. It is my hope, that through the improvement of water perceptions and making enjoyable drinking water readily available, we will see less sugar-related chronic diseases like dental decay and less plastic waste in our community.

1. Patel AI, et al. Drinking Water in the United States: Implications of Water Safe, Access, and Consumption. Annual Review of Nutrition. 2020;40(1):345-73.

2. Delpla I, et al. Perception of tap water quality: Assessment of the factors modifying the links between satisfaction and water consumption behavior. Sci Total Environ. 2020;722:137786.

Dr. David Thai is the Dental Director at West County Health Centers. Through the UCSF Champion Provider Fellowship Program, Dr. Thai has been working with the Department of Health Services of Sonoma County, along with community partners, to increase water consumption in rural Sonoma County.