Dental experts are sounding the alarm after US Health and Human Services (HHS) Secretary Robert F. Kennedy Jr. said April 7 he wants the CDC to stop recommending water fluoridation.
That same day, the Environmental Protection Agency (EPA) shared plans to prepare a new assessment of fluoride’s health effects, prompted by an August review by the HHS National Toxicology Program that had found, “with moderate confidence,” an association between exposure to fluoride above 1.5 mg/L and lower IQ in children. (The NTP stressed that there was “insufficient data” to evaluate whether the US’s lower 0.7 mg/L fluoride level currently recommended by HHS is associated with low IQ or health risks.)
“Without prejudging any outcomes, when this evaluation is completed, we will have an updated foundational scientific evaluation that will inform the agency’s future steps to meet statutory obligations under the Safe Drinking Water Act,” EPA Administrator Lee Zeldin said in an April 7 release.
On April 15, a coalition of 250+ research and professional organizations signed a letter to Congress sharing “deep fear” about the prospect of ending community water fluoridation.
“The US does not have capacity in the oral health workforce to support the emergency, surgical, and restorative dental needs that would result,” read the letter, signed by groups including the American Dental Association and American Academy of Pediatric Dentistry.
Already, as of 2024, approximately 57 million people—primarily from lower-income households and certain minority groups—in the US live in a dental health professional shortage area, according to the CDC.
“There are groups that…have terrible problems with tooth decay, and that is only going to get worse [without fluoride],” Margherita Fontana, professor and chair of the department of cariology and restorative sciences and endodontics at the University of Michigan School of Dentistry, told Healthcare Brew.
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What is fluoride? Fluoride is a mineral that’s already naturally present in some communities’ water. Starting in 1945 with Grand Rapids, Michigan, municipalities worldwide began adding extra fluoride to their water supply to prevent cavities and tooth decay. Today, about 72% of the US population served by community water systems receives fluoridated water.
The CDC previously called community water fluoridation “one of the 10 greatest public health achievements of the 20th century.”
“This is a natural element on Earth. It’s very common…and it’s very safe when used at very low levels. And those are the levels that normally we adjust fluoride [to] in the water,” Fontana said.
Looking forward. It’s unclear what the future holds for fluoride. Even if the CDC does change its recommendation, communities don’t have to follow it. But many seem to be on board with ending public water fluoridation.
In March, Utah became the first state to pass a ban on the practice, and since then, large counties including Miami-Dade in Florida have followed suit and a statewide ban is making its way through the Florida Legislature.
Some areas, like Calgary in Alberta, Canada, stopped adding the mineral years ago. But Calgary is now re-adding fluoride to its water supply following a jump in dental decay and cavity treatments since the 2011 removal.
As of publication, the CDC still has a webpage that promotes the “safety and benefits” of community water fluoridation, though the White House put out a statement defending Kennedy’s stance on April 8. HHS did not provide additional comment.