Behind The Growing Push To Ban Cavity-Fighting Fluoride In Our Drinking Water

Two states — Utah and now Florida — have now banned cavity-preventing mineral fluoride additives in public drinking water supplies, sparking concern among dentists that tooth decay will become more common among vulnerable populations.

More states are expected to follow. The Ohio and South Carolina legislatures are considering similar measures, despite arguments from dentists and dental health experts that removing fluoride will harm tooth development, especially in young patients without regular access to dental care.

Below are five things to know.

A Shift In Health Policy

The states’ moves come during a new era in the nation’s health care policy, overseen by Health and Human Services Director Robert F. Kennedy Jr.

A former environmental lawyer, Kennedy in the past has called fluoride a “dangerous neurotoxin” and has said it has been associated with arthritis, bone breaks and thyroid disease. While some studies have suggested such links may exist, they’ve found it’s usually at higher-than-recommended fluoride levels. Reviewers also have questioned the quality of available evidence and have said no definitive conclusions can be drawn.

Kennedy said last fall that President Donald Trump would ban fluoride by executive order on his first day in office. That didn’t happen. Kennedy doesn’t have the authority to order communities to stop putting fluoride in water, but in April, he said he would direct the Centers for Disease Control and Prevention to stop recommending fluoride be added to water systems.

At the same time, the Environmental Protection Agency said it was reviewing “new scientific information” on the potential health risks associated with fluoridation.

The EPA said in a news release that scientists with the National Toxicology Program concluded with “moderate confidence” that fluoride at certain levels is associated with lower IQs in children but also said more research is needed.

Dentists Offer To Clear Up The Issue

The American Dental Association has offered to conduct high-quality studies to settle the issue, PBS reported.

“When government officials like Secretary Kennedy stand behind the commentary of misinformation and distrust peer-reviewed research, it is injurious to public health,” the association’s president, Brett Kessler, told PBS.

Utah Oral Health Coalition chairperson Lorna Koci told PBS that she hopes other states push back against the removal of fluoride, and that Kennedy’s visit to celebrate her state’s fluoride ban underscores the political motivations of those who support it. Kennedy praised Utah for its stand against fluoride, calling the state “the leader in making America healthy again.”

“This seems to be less about fluoride and more about power,” Koci said.

Fluoridation A Public Health Milestone

Communities began adding fluoride to their drinking water systems in 1945 in what the CDC said was one of 10 great public health achievements of the 20th century because of the dramatic decline in cavities.

About two-thirds of Americans live in places where fluoride is added to the drinking water. Fluoride fortifies teeth and reduces cavities by replacing minerals lost during normal wear and tear, according to the CDC. It’s especially important that children whose teeth are still developing have a source of fluoride, according to the agency. For some low-income families, public drinking water containing fluoride may be their only source of preventative dental care, advocates warn.

The National Institutes of Health has said it is “virtually impossible” to get a toxic dose from fluoride added to water or toothpaste at standard levels.

In Utah, dentists already have a fair idea what will happen. The state ranks 44th in the country for the percentage of residents receiving fluoridated water, with about 2 in 5 receiving it in 2022, according to CDC data.

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“Any dentist can look in someone’s mouth in Utah and tell exactly where they grew up. Did you grow up in a fluoridated area or a non-fluoridated area? We can tell by the level of decay,” Dr. James Bekker, a pediatric dentist at the University of Utah in Salt Lake City, told The Associated Press.

The new laws in Utah and Florida and under consideration elsewhere are a failure of public policy, according to the American Dental Association’s Kessler.

“As dentists, we see the direct consequences fluoride removal has on our patients and it’s a real tragedy when policymakers’ decisions hurt vulnerable kids and adults in the long term,” Kessler said in a statement earlier this month. “Blindly calling for a ban on fluoridated water hurts people, costs money, and will ultimately harm our economy.”

‘People Deserve Informed Consent’

Fluoridation opponents also say they have no freedom of choice in the matter. Many don’t dispute the mineral’s dental health benefits, only that the government shouldn't force it on them without their informed consent.

“Jamming fluoride in the water supply … is essentially a forced medication,” Florida Gov. Ron DeSantis said at a news conference Tuesday after he signed legislation effectively banning fluoride in the state’s public drinking water supplies. “At the end of the day, we should all agree that people deserve informed consent.”

• Read the related story: Florida Follows Utah As 2nd State To Ban Fluoride

DeSantis also posted on X, “With wide access to topical fluoride, there’s no need to medicate entire communities without their consent. The Free State of Florida says no to forced medication, and we’re proud to lead the nation on this effort!”

What Do Laws Do?

The law in Utah shifts responsibility to individuals, which means residents will have to be proactive about their dental health.

Florida’s bill doesn’t specifically mention fluoride, but it will require the mineral and some other additives be removed from water sources across the state

“Anything that relates to water quality, removing contaminants, things like that, we're not touching that,” the Florida bill’s sponsor, Republican state Rep. Kaylee Tuck, told The AP. “It's anything that has to do with health. So fluoride, vitamins, whatever else it is.” it will require the mineral and some other additives be removed from water sources across the state, said bill sponsor Republican state Rep. Kaylee Tuck.

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Some local officials in Florida have already voted to remove the mineral from their community water supplies, ahead of state lawmakers' push to ban fluoride.

Toothpaste with fluoride doesn’t provide enough of the mineral to prevent tooth decay, and dentists worry that patients who already are unable to afford only emergency dental care won’t be able to afford fluoride tablets for drinking water or other supplements.

Fluoride tablets currently require a prescription from a doctor or dentist. Providers are working with lawmakers to reclassify the tablets for over-the-counter purchase, but the changes could be months or years away.

The Associated Press contributed reporting