With fluoride in so many dental products, some say adding it to drinking water is no longer necessary. But health experts worry that, like vaccines, fluoridation may be a victim of its own success.
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MONROE, NC — Regina Barrett, a 69-year-old retiree who lives in this small North Carolina town southeast of Charlotte, hasn’t been happy with her tap water for a while.
“Our water was cloudy and frothy and looks milky,” said Barrett, who blames fluoride, a mineral that communities across the country have for decades added to their water supplies to help prevent tooth decay and improve of dental health.
“I don’t want fluoride in my nothing!” Barrett said, echoing a growing number of people who not only doubt the mineral’s effectiveness, but also believe it may be harmful despite decades of data showing public health and economic benefits.
In February, the Board of County Commissioners in Monroe-based Union County voted 3-2 to stop adding fluoride to drinking water at the Yadkin River Water Treatment Plant, the only wholly owned water source and operated by the county. But the decision came after heated debate between residents and county officials.
“My children were blessed to grow up with fluoride in their water and … they have very few dental problems,” Commissioner Richard Helms said before the vote. A fellow Commissioner saw it differently: “Let’s stop putting something in the water that is meant to treat us and give people the freedom to choose,” said David Williams.
Barrett’s water comes from the city of Monroe, not the Yadkin facility. So, for now, he will continue to drink fluoridated water. “I’m suspicious because they’re adding it to our water,” he told KFF Health News.
It’s a scenario played out nationwide. From Oregon to Pennsylvania, hundreds of communities in recent years have either stopped adding fluoride to their water supplies or voted to prevent it from being added. Proponents of such bans argue that people should be given the freedom of choice. The widespread availability of over-the-counter dental products containing the mineral no longer makes adding it to public water supplies necessary, they say. The Centers for Disease Control and Prevention says that while store-bought products reduce tooth decay, the greatest protection comes when used in combination with water fluoridation.
The outcome of an ongoing federal case in California could force the Environmental Protection Agency to create a rule regulating or banning the use of fluoride in drinking water nationwide. Meanwhile, the trend raises alarm bells for public health researchers who worry that, like vaccines, fluoride may have become a victim of its own success.
The CDC maintains that community water fluoridation is not only safe and effective but also yields significant cost savings in dental treatment. Public health officials say removing fluoride could be particularly harmful to low-income families — for whom drinking water may be the only source of preventive dental care.
“If you have to go out and take care of it yourself, it’s a whole different ball game,” said Myron Allukian Jr., a dentist and former president of the American Public Health Association. Millions of people have lived with fluoridated water for years, “and we haven’t had any major health problems,” he said. “It is much easier to prevent a disease than to cure it.”
According to the anti-fluoride group Fluoride Action Network, as of 2010, more than 240 communities around the world have removed fluoride from their drinking water or decided not to add it.
One need only look to Union County to see how heated the debates can be. Usually when commissioners meet on the first floor of the Government Center in downtown Monroe, there are more empty seats than people in attendance. But the sessions on banning fluoride from public water supplies were packed, and residents who signed up to speak were divided.
One person who came to the microphone on February 5 compared water fluoridation to a seat belt. It doesn’t “prevent the car accident, but it limits the damage caused,” he said. Another argued that there is no proof that fluoride is safe or effective. “It’s an important potential milestone in reversing 60-plus years of poisoning the public,” he said, using an unproven claim often made by opponents of fluoridation.
Opponents of fluoride claim the mineral is responsible for everything from acne to high blood pressure and thyroid dysfunction to bone cancer.
The National Institutes of Health acknowledges that, when ingested in extremely large amounts, fluoride from dental products or dietary supplements can cause nausea, vomiting, abdominal pain, diarrhea, bone pain, and even death in extremely rare cases.
Infants and children who receive too much fluoride may develop discoloration or small dents in their teeth. In adults, its consumption excessive fluoride for prolonged periods it can lead to skeletal fluorosis, a very rare condition that causes joint pain and stiffness, weak bones, muscle wasting and nerve problems.
However, the recommended dose in drinking water has always been small. In 2015 the Department of Health and Human Services lowered the optimum fluoride concentration from 1.2 milligrams per liter to 0.7 mg/L.
Juneau, Alaska voted to remove fluoride from its drinking water in 2007. A study published in the journal BMC Oral Health in 2018 compared the dental records of children and adolescents who received dental care for decayed teeth four years before and five years after the city stopped adding fluoride to the water. Cavity-related procedures and treatment costs were significantly higher in the latter group, the study found.
Portland, Oregon is the largest city in the nation that has a stable refused to fluorine its drinking water. Voters have repeatedly rejected measures to add it, first in 1956 and most recently in 2013.
Despite strong recommendations from local doctors and dentists, voters in Wichita, Kansas have repeatedly rejected adding fluoride to the water, most recently in 2012.
Brushy Creek Municipal District in Williamson County, Texas, had been adding fluoride to its water system since 2007, but ended the practice in December.
In 2016, in Collier County, Florida, commissioners chose not to remove fluoride from the water system. But they unanimously reversed that decision after a 2023 Health Freedom Bill of Rights prefectural decree in response to Covid-19 “to safeguard the health care rights and freedoms of the residents of Collier County.”
The Pennsylvania State College Water Authority stopped adding fluoride to the water of its 75,000 customers in March 2023. Officials used claims often raised by fluoride opponents, such as potential environmental contamination, concerns about medical freedom and possible adverse health effects, such as the possibility of faint white lines in the teeth and lowered IQ for babies.
ONE study published in JAMA Pediatrics in 2019, conducted in six Canadian cities, linked fluoride exposure during pregnancy to lower IQ scores in children. But the study relied on self-reporting and has been criticized for its methodological shortcomings.
In 2016, several consumer advocacy groups, including the Fluoride Action Network, Food & Water Watch, and Moms Against Fluoridation, called on the EPA to end water fluoridation under the Toxic Substances Control Act, arguing that significant research showed that fluoride was neurotoxic in the doses now. used. The same group filed a federal lawsuit against the EPA the following year after the agency dismissed its citizens’ petition.
During a 10-day trial in San Francisco that ended in mid-February, the two sides discussed risks and areas of uncertainty. If Senior US District Judge Edward Chen rules that water fluoridation poses an “unreasonable risk” to human health, the EPA will be forced to create a rule to regulate or ban water fluoridation in the US. The decision is expected soon.
For now, decisions about whether to fluoridate community water systems are still mostly made at the local level, something Barrett hopes will change.
“After all, they want our teeth healthy when the basic needs of shelter and food are lacking.”
KFF Health News is a national newsroom that produces in-depth health journalism and is one of its core operating programs KFF — an independent source for health policy research, polling and journalism.
