As the Trump administration takes steps to discourage the incorporation of fluoride in drinking water, experts warn the moves may have serious consequences for Americans’ health.
The Environmental Protection Agency (EPA) on Monday announced it would “expeditiously review new scientific information on potential health risks of fluoride in drinking water.”
The move came after a judge last year required the agency to take a second look at fluoride due to potential concerns.
Meanwhile, Health and Human Services Secretary Robert F. Kennedy Jr. told reporters Monday that he would direct the Centers for Disease Control and Prevention (CDC) to stop recommending fluoride in drinking water.
Kennedy was in Utah, which banned adding fluoride to drinking water starting in May.
“I’m very, very proud of this state for being the first state to ban it, and I hope many more will,” he said.
Why is fluoride added to water?
Fluoride is a naturally occurring mineral used for its ability to help prevent cavities in teeth. It does so by replacing the minerals in your teeth that would otherwise be lost to acid coming from bacteria in your mouth.
Fluoride can naturally be found in water — but typically at levels that are too low to prevent cavities, so state and local governments across the country have often added it in.
Municipal water fluoridation has been practiced in the U.S. since 1945 when Grand Rapids, Mich., became the first city to implement the practice.
The federal government’s role largely consists of making recommendations on concentration. The U.S. Public Health Service currently recommends a maximum of 0.7 milligrams of fluoride per liter of water.
According to the CDC, more than 209 million people in the U.S. — 72.3 percent of the U.S. served by a public water system — had access to fluoridated water in 2022, and 11 million people had access to community water systems with naturally occurring levels of fluoride above the recommended concentration.
According to the CDC, this added fluoride reduces cavities by about 25 percent in children and adults.
Scott Tomar, spokesperson at the American Dental Association and professor at the College of Dentistry at the University of Illinois Chicago, noted that dental health can be important not just for your teeth — but for your overall health.
“The mouth, the teeth, have a substantial impact on pretty much every aspect of people’s lives — certainly their health,” he said. “An infection of your tooth becomes an infection of the surrounding area and often spreads to other parts of the body.”
He said that fluoride in drinking water can help prevent not only tooth decay, but also infections.
“In places that have stopped fluoridation, not only did they see an increase in the rates of tooth decay, starting with young children,” he added. “They saw [an] increase in the rate of emergency care.”
Recent scrutiny of fluoride
There has been pushback to water fluoridation since the practice became popular, and in recent years opponents to the practice have expressed concerns over potential impacts on IQ.
The National Toxicology Program released a study last year associating high levels of fluoride — 1.5 milligrams per liter — with lower IQ in children, but researchers noted it was unclear if the low levels of fluoride used in U.S. water systems have the same effect.
Because the 1.5 mg/L level is much higher than levels used in the U.S., Tomar said “it simply has no relevance to the levels of exposure we have in this country.”
However, based largely on the National Toxicology Program’s assessment, a judge last year ordered the EPA to consider taking action to address the potential IQ impacts from fluoride.
The ruling from Obama appointee Edward Chen did not necessarily say that fluoride at current levels is unsafe. But Chen raised concerns that the agency was using an inadequate margin of error.
“The EPA’s default margin of error … requires a factor of 10 between the hazard level and exposure level due to variability in human sensitivities. Put differently, only an exposure that is below 1/10th of the hazard level would be deemed safe,” he wrote.
So is flouride safe?
Many experts say yes.
“We have about 80 years of evidence that community water fluoridation is effective at preventing tooth decay and is safe at the levels that we use it,” Tomar said.
Kennedy has long spoken out against fluoride, calling it a “toxic pollutant” and “industrial waste.” Shortly before the 2024 presidential election, he said he would advise all water systems to remove the mineral.
Experts say the available data doesn’t support the level of criticism fluoride receives.
“They’re not looking at the science and they don’t want to look at the science, because that’s not how they’re thinking,” said Myron Allukian Jr., former city of Boston dental director and past president of the American Public Health Association.
“It’s going to set our country back. It’s going to make America sick again.”
Critics also argue the ubiquity of fluoride toothpaste makes water fluoridation unnecessary, but Allukian said adding it to drinking water confers benefits beyond brushing, allowing the mineral to become part of developing teeth and thus more resistant to cavities.
Allukian noted that every surgeon general from the Eisenhower to the Biden administration has supported adding fluoride to water as a “scientifically safe and effective public health measure.”
