Fluoride supporters, it appeared, had everything going for them.

Five Portland city commissioners had voted to add fluoride to the city water supply. Health advocacy groups, and many of the city's communities of color, lined up behind the cause. And proponents outraised opponents 3-to-1.

But none of that was enough. For the fourth time since 1956, Portlanders on Tuesday night rejected a plan to fluoridate city water, 60 percent to 40 percent.