According to a Reuters report, Robert F. Kennedy Jr., the head of the Department of Health and Human Services, has suggested that U.S. President Donald Trump might propose ending the practice of adding fluoride to public water systems. While Trump has not made his stance public, he hinted that he could consider such a move.
Recent discussions on this topic have been fueled by new research studies highlighting the potential risks and advantages of fluoride exposure. Here is a summary of what you need to understand about the fluoridation of drinking water as a public health strategy.
### What is Fluoride and How Does it Benefit Us?
Fluoride is a natural mineral found in water, soil, and air that has been proven to prevent tooth decay by strengthening the enamel, the outer layer of the tooth. This makes the tooth more resistant to the acids produced by bacteria that cause decay. Fluoride can also help reverse early tooth decay by replenishing and protecting minerals in the teeth.
Before the introduction of community water fluoridation, tooth decay was prevalent and severe among Americans. However, after fluoride was added to many U.S. water supplies, both children and adults experienced a decline in tooth decay, and complete tooth loss in older adults became less common, as stated by federal health authorities.
### Recent Studies on Fluoride Benefits
A study released in January by researchers at the U.S. National Institutes of Health examined 74 studies from 10 countries and found that children with higher fluoride exposure had lower IQs. The report highlighted that urinary fluoride levels, common in developed countries, were associated with reduced IQ scores in children. This raised concerns for vulnerable populations residing in communities with fluoridated water, according to an accompanying editorial. However, another editorial pointed out several limitations in the NIH analyses and cautioned against altering public policy based on these findings.
In October 2024, a review published by the Cochrane Database of Systematic Reviews questioned the effectiveness of water fluoridation in affluent countries, drawing from 157 studies. The research suggested that, given the widespread use of fluoride toothpaste since 1975, the benefits of community water fluoridation in reducing tooth decay and increasing cavity-free children might be modest compared to earlier findings. Legal challenges are also emerging regarding the safety of fluoride levels in toothpaste.
The review also noted a lack of evidence to determine the repercussions of discontinuing fluoridation and its impact on socio-economic disparities in dental health.
### The History of Water Fluoridation Policy
In the early 20th century, U.S. researchers noticed that individuals in regions with naturally high fluoride levels in their drinking water had fewer instances of tooth decay. This observation led to the controlled addition of fluoride to the water supply of Grand Rapids, Michigan, in 1945, marking the beginning of a significant public health initiative. Data collected over a 15-year period revealed a substantial reduction in tooth decay
The success of water fluoridation in reducing cavities has been acknowledged by the Service and the American Dental Association. This recognition led to the widespread adoption of adding fluoride in community water supplies in the United States, as well as its inclusion in dental products like toothpaste and mouthwash. It’s important to note that there is no federal law mandating water fluoridation; typically, decisions regarding fluoridation are made by municipal governments, city councils, or local water authorities.
In the United States, approximately 63% of the population has fluoride in their community water systems according to CDC statistics from 2022. The cost for communities to fluoridate their water supplies can range from 50 cents to $3 per person per year, depending on the community size. While fluoridation of public water supplies is common in the U.S., in most parts of the world fluoride is not added to water and is sometimes added to table salt or occurs naturally in water sources.
Regulation of fluoride levels is important to prevent health risks. The U.S. Public Health Service recommends that fluoride levels in drinking water remain below 0.7 milligrams per liter, as levels above 1.5 mg/L can lead to health issues such as bone fractures, thyroid disease, and nervous system damage. The enforceable limit set by the U.S. Environmental Protection Agency is 4.0 mg/L, with recent calls to strengthen these regulations.
Fluorosilicic acid is the compound commonly used in water systems to provide fluoride. Companies like J.R. Simplot and Nutrien’s PCS Phosphate Company are involved in manufacturing this product. In 2019, the total U.S. domestic production of fluorosilicic acid from phosphate rock was approximately 29 million kilograms (32,000 tons).
Public health experts support water fluoridation as a significant achievement in preventing tooth decay. The U.S. Centers for Disease Control and Prevention and the American Dental Association endorse community water fluoridation as an effective measure, reducing tooth decay by more than 25% in both children and adults. Studies have shown that adding fluoride to the water supply has greatly improved dental health with minimal risks of adverse effects, as noted by Kellogg Schwab of Johns Hopkins Bloomberg School of Public Health.
While there is overwhelming support for water fluoridation from public health experts, some officials like Florida Surgeon General Joseph Ladapo have expressed differing views on the practice.
Opponents have strongly cautioned against the addition of fluoride to public water systems, referencing unreliable research that hints at potential harm to the cognitive development of young individuals. This information was collated by a group of Reuters journalists and was refined by the efforts of Nancy Lapid, Bill Berkrot, and Lisa Shumaker during the editing process.
