In Leslie, Arkansas, David Potts receives dental care from James Flanagin, the sole dentist in town who operates from a small clinic in the back of an antique store. Recent research from Harvard University indicates that approximately 25 million Americans reside in areas with limited access to dental care. – Katie Adkins/KFF Health News
In the forested highlands of northern Arkansas, where small communities face a scarcity of dentists, the water officials serving over 20,000 residents have been openly defying state laws for more than ten years by not adding fluoride to the drinking water supply. Despite receiving numerous state fines totaling around $130,000, which remain unpaid and stored in a cardboard box, Andy Anderson, a fluoridation opponent who has overseen the water system for nearly two decades, remains steadfast in the refusal to fluoridate the water.
The Ozark Mountain Regional Public Water Authority is just one of many rural communities across America grappling with a dual challenge to oral health: a severe lack of dentists and absence of fluoridated water, a key tool in preventing tooth decay endorsed by dental experts. While the anti-fluoride movement gains momentum, challenging the traditional view on fluoride, individuals like Anderson believe their stance will ultimately be validated.
Fluoride, a naturally occurring mineral that bolsters tooth strength when added to water, is endorsed by the Centers for Disease Control and Prevention and the American Dental Association. However, concerns surrounding fluoride have grown following a government report suggesting a potential link between high fluoride consumption and lower IQ in children. This has prompted several communities to halt fluoridation, with states like Florida and Texas urging water systems to follow suit. Utah recently became the first state to ban fluoride in tap water this month.
Robert F. Kennedy Jr., the Health and Human Services Secretary, has labeled fluoride as an “industrial waste” and “dangerous neurotoxin,” signaling that the Trump administration may recommend its removal from public drinking water. Additionally, proposed Republican measures to reduce federal spending could impact Medicaid, exacerbating the existing shortage of dentists in rural areas where many rely on the program for dental care.
Experts caution that the potential combination of Medicaid cuts and reduced fluoridation could intensify the rural oral health crisis, undoing years of progress in combating tooth decay, particularly among children and underserved populations. Steven Levy, a leading fluoride researcher and dentist at the University of Iowa, emphasizes the importance of professional care and water fluoridation in maintaining lifelong oral health.
In Leslie, Arkansas, where unfluoridated water is the norm, James Flanagin serves as the town’s sole dentist, operating out of an antique store on Main Street. – Katie Adkins/KFF Health News
With nearly 25 million Americans residing in regions lacking adequate dental care, efforts are needed to address the growing concerns of both dental shortages
A recent study conducted by Harvard University provided a more in-depth and precise analysis of U.S. “dental deserts.” Hawazin Elani, a Harvard dentist and epidemiologist involved in the research, discovered that many of these underserved areas are rural, impoverished, and heavily reliant on Medicaid. However, due to low payments, many dentists do not accept Medicaid patients. The American Dental Association (ADA) estimates that only a third of dentists treat Medicaid patients, leaving beneficiaries struggling to find care.
The study identified over 780 counties where more than half of the residents reside in shortage areas. Among these counties, at least 230 have public drinking water that is either mostly or completely devoid of fluoride. This lack of fluoridation further compounds the oral health challenges faced by residents in these areas, as fluoride helps protect teeth from decay.
Emerging patterns show that most counties with a shortage of dentists and unfluoridated water are concentrated in the south-central U.S., spanning from Texas to the Florida Panhandle and reaching up into Kansas, Missouri, and Oklahoma. A notable case is the Ozark Mountain Regional Public Water Authority, which serves several Arkansas counties. Despite statewide fluoride mandates, the water authority has refused to add fluoride, citing health concerns.
In Leslie, Arkansas, a small community relying on the Ozark water system, the sole dentist operates out of a modest clinic within an antique store. James Flanagin, the town’s only dentist, highlights the increased tooth decay rates in areas without fluoridated water. He stresses the importance of fluoride in preventing oral health issues and notes the visible impact of its absence on the community’s dental health.
Fluoridation of public water has been recognized as a significant public health achievement, dating back to its introduction in 1945. By 1980, fluoride had been added to water supplies serving half of the U.S. population, contributing to improved oral health outcomes across the country.
According to the CDC, fluoridation has led to a significant decrease in cavities, earning it a spot as one of the top 10 public health achievements of the 20th century in 1999. Currently, over 70% of the U.S. population on public water systems receive fluoridated water with a recommended concentration of 0.7 milligrams per liter. Fluoride can also be found in toothpaste, mouthwash, dental varnish, as well as in certain foods and drinks like raisins, potatoes, oatmeal, coffee, and black tea.
Despite the widespread support for fluoridation, there is a minority who oppose it. Recent polls have indicated that around 48% and 40% of respondents are in favor of keeping fluoride in public water supplies, while 29% and 26% support its removal. Dental experts are concerned that misinformation about fluoride could lead to decreased use of fluoridated products, especially among low-income families. This, combined with Medicaid cuts impacting access to dental care, could have a detrimental impact on oral health.
Studies have shown that discontinuing water fluoridation can lead to a significant increase in cavities, as seen in cities that halted fluoridation compared to those that continued. Despite the proven benefits of fluoridation, it has faced opposition since its introduction, with unfounded claims ranging from being a communist plot to causing cancer and AIDS. More recently, concerns have been raised about potential impacts on children’s brain development, with some studies suggesting a link between high fluoride levels and lower IQ.
It is important to consider the scientific evidence supporting fluoridation in order to make informed decisions about public health policies.
A federal judge in California has deemed the potential connection between fluoride and decreased IQ too significant to overlook. As a result, the judge has instructed the federal Environmental Protection Agency (EPA) to take unspecified measures to mitigate this risk. The EPA has initiated an appeal against this ruling during the concluding days of the Biden administration, but there is a possibility that the Trump administration may reverse course.
In northern Arkansas, a storage tank managed by the Ozark Mountain Regional Public Water Authority is holding water without the addition of fluoride, defying a state law that mandates fluoride in drinking water for over a decade.
Katie Adkins/KFF Health News reported on this development. The EPA and Department of Justice have opted not to provide comments. Inquiries directed at the White House and the Department of Health and Human Services regarding fluoride have gone unanswered.
Dr. Hayes mentioned that despite the National Toxicology Program’s findings, no conclusive link has been established between reduced IQ and the fluoride levels present in the majority of Americans’ water supply. The court’s decision may stimulate further research within the U.S., potentially putting an end to the anti-fluoride movement, according to Hayes.
Not all experts share the same perspective on the toxicology program’s report. Bruce Lanphear, a children’s health researcher at Simon Fraser University, has expressed concerns regarding the risks and benefits of fluoride, particularly for pregnant women and infants. He emphasized the need for those advocating for fluoridation to demonstrate its safety.
Several states have recently considered or are contemplating bills to eliminate fluoride mandates or ban fluoride from drinking water. Utah Governor Spencer Cox signed the nation’s first ban, effective May 7. Officials in Florida and Texas have also called for the discontinuation of water fluoridation in their respective states.
Stuart Cooper, executive director of the Fluoride Action Network, anticipates a growing movement against fluoride, with many U.S. communities ceasing fluoridation in the coming years. This trend, Cooper believes, will lead to a significant decline in fluoridation nationwide.
Hayes warned that if widespread discontinuation of fluoridation occurs, increased dental decay could become apparent within a few years, resulting in unnecessary suffering among children.
Throughout this country, there is a growing queue of children waiting to access the operating room for dental treatments due to severe decay caused by a lack of fluoridated water or other fluoride sources. This situation is expected to worsen over time. Holly K. Hacker, data editor at KFF Health News, provided valuable input for this article. KFF Health News is a national news organization dedicated to producing comprehensive reporting on health-related topics and is a key initiative at KFF – an independent authority for health policy research, polling, and journalism. To stay updated with more CNN news and newsletters, sign up for an account at CNN.com.
