Health Secretary Robert F. Kennedy Jr. is following through on his pledge to order the CDC to stop recommending that US communities add fluoride to their drinking water.
The debate over fluoride’s potential benefits and risks continues to spark controversy, with Kennedy — an outspoken critic — announcing this week that he’s assembling a task force to get to the bottom of the issue.
With oral health closely tied directly to our overall well-being, the stakes couldn’t be higher. The Post consulted two experts to break down where the science stands on fluoride. Here’s everything you need to know.
Why is fluoride put in our water?
Fluoride is a naturally occurring mineral found in soil, water, plants and even many foods.
The practice of adding fluoride to US drinking water began in Grand Rapids, Michigan, in 1945 as an effort to reduce tooth decay. After 10 years, local dentists reported a jaw-dropping 60% reduction in cavities among children.
Fast-forward to today: About one-third of US community water systems serve more than 60% of the population with fluoridated water, according to the CDC. In some areas, fluoride naturally occurs at levels high enough to fight cavities.
State and local governments currently decide whether to fluoridate water. However, last year, a California judge ordered the EPA to strengthen regulations for water fluoridation nationwide.
What are the benefits of fluoride in water?
The CDC has hailed addition of fluoride to drinking water as one of the greatest public health triumphs of the last century.
Fluoride helps prevent tooth decay in two ways, according to Dr. Scott Schwartz, a pediatric dentist and trustee-elect of the of the Board of Trustees of the American Academy of Pediatric Dentistry, which supports community water fluoridation.
“First, fluoride helps to remineralize, or strengthen, teeth that may have tooth decay. In fact, teeth are stronger after fluoride gets incorporated than they are naturally,” Schwartz said.
“In addition, fluoride helps kill the bacteria that cause cavities,” he noted.
Tooth decay, or cavities, is a common and preventable chronic disease. According to the CDC, drinking fluoridated water can reduce your risk by about 25% in both children and adults.
“Preventing cavities cuts down on toothaches, reduces the need for dentist visits and fillings, and keeps children in school and parents working,” said Dr. Donald Chi, a pediatric dentist and associate dean for research at the University of Washington’s School of Dentistry.
“Water fluoridation is even more important for individuals from lower-income communities because it may be their only source,” he added.
And the benefits aren’t just for teeth — it’s a win for wallets too. Communities with fluoridated water save an average of $32 per person each year by avoiding the cost of treating cavities, according to the CDC.
Are there risks associated with consuming too much fluoride?
Kennedy has criticized fluoride, calling it “industrial waste” and arguing that adding it to drinking water can harm brain development, bone health and cause other issues.
“Like anything, too much of a good thing is a bad thing,” Schwartz said. “For example, chlorine is added to both community water supplies and swimming pools to kill microbes and improve safety — the difference in how much is key.”
Drinking water should not contain more than two milligrams per liter of fluoride, according to the EPA. If levels exceed this amount, water systems are required to alert customers.
When it’s over four milligrams per liter or higher, the CDC suggests using a “filter that removes fluoride from water.” Long-term, that level of fluoride can lead to skeletal fluorosis, causing risks of weaker bones in the elderly, joint stiffness and more.
Schwartz outlined two main concerns he frequently hears from the public regarding fluoride in drinking water.
“The most recent concerns involve fluoride’s role as a neurotoxin, specifically a reduction in IQ scores and calcification of the pineal gland,” he said.
An August report from the federal National Toxicology Program, after reviewing fluoride research, concluded with “moderate confidence” that higher levels of fluoride are associated with lower IQ in children.
However, the American Dental Association fired back, arguing that the studies on which the report was based were flawed because they primarily focused on countries with far higher levels of fluoride than what is considered safe in the US.
The review did not determine whether the low fluoride level of 0.7 mg/L currently recommended for US community water supplies has any negative effect on children’s IQ.
Another common concern is the impact fluoride may have on developing teeth.
“Too much fluoride incorporated into a tooth that is developing can cause a condition called fluorosis,” Schwartz explained. Fluorosis is primarily a cosmetic issue, ranging from slight discoloration to dark staining or roughness on the tooth surface.
In light of these concerns, Schwartz said the US Public Health Service lowered its recommendation for fluoride levels in community water systems in 2015 to strike a better balance between fluoride’s benefits and the risk of fluorosis.
“[This] further demonstrates that organizations such as the CDC and FDA are routinely reviewing levels to ensure maximum safety for the American public,” Schwartz said.
Where has fluoride already been removed from drinking water?
As scientific questions around the risks and benefits of fluoride remain unresolved, critics argue that people shouldn’t be forced to drink it. This has led to a growing number of communities rejecting the public health practice.
Since 2010, more than 170 communities across the country have chosen to move fluoride from their drinking water, including places like Oneida, New York; Portland, Oregon; and Bucks County, Pennsylvania, according to the Fluoride Action Network, which opposes the practice of adding fluoride to public water supplies.
Last month, Utah made history by becoming the first US state to outlaw the addition of fluoride to public drinking water. Anti-fluoridation bills have also been introduced in states like North Dakota, Tennessee and Montana.
What happens when fluoride is no longer added to water?
Chi warned these moves could have serious consequences, particularly in low-income communities that rely on drinking water as their primary source of fluoride.
“This means more drilling on teeth and more teeth having to be removed, which will make life even harder for lower-income families, many of whom already have difficulties finding dentists for their children,” he said.
Chi’s concerns aren’t just hypothetical. While only a handful of studies have looked at the effects of fluoride removal, they show a clear trend: the number of cavities rises.
Take Juneau, Alaska’s capital city, for example. After removing fluoride from its water in 2007, a 2018 study found that children under 7 in areas without fluoridated water required about 34% more dental procedures than children in fluoridated areas.
“Without improving health in other aspects, removing fluoride from the water will put the oral health of millions of Americans at risk,” Schwartz warned.
What are some alternative sources of fluoride?
If you live in a community that has banned fluoride or is thinking about it, there are still plenty of ways to make sure you’re getting enough of the mineral.
Fluoridated toothpaste and mouth rinses are easy to find at your local store, and for those at high risk of tooth decay, dentists can prescribe fluoride supplements or provide special treatments to help boost your fluoride intake.
But it’s not all about brushing your teeth. Fluoride naturally occurs in a variety of foods, including green and black tea, fish, shellfish, oatmeal, raisins, and potatoes.
And if you’re looking to boost your intake without changing your diet, you can use fluoridated table salt when cooking.
