Twenty-five years ago, the Centers for Disease Control and Prevention named fluoridation among the 10 greatest public achievements of the 20th century. Today, lawmakers in more than a dozen states are considering bills to prohibit or restrict adding fluoride to public water supplies.
A bill to ban fluoride from water supplies altogether is sitting on Utah Gov. Spencer Cox’s (R) desk, after lawmakers gave the measure final approval last week. Florida lawmakers are likely to follow suit after state Surgeon General Joseph Ladapo formally advised local governments to stop fluoridating their water in November.
Lawmakers in Hawaii, Louisiana, Massachusetts, Mississippi, Montana, New Hampshire and North Dakota have introduced their own versions of Utah’s prohibition. Most of those bans would allow a pharmacist to prescribe fluoride to those who wish to take it.
In Arkansas, Kentucky, Massachusetts and Nebraska, bills would repeal existing laws that mandate the use of fluoride in public water systems. Those bills would allow local residents to vote to opt out of fluoridation.
Bills in Tennessee and Texas would require utility operators to disclose the amount of fluoride in their water supplies. (Texas lawmakers are also expected to introduce a bill prohibiting fluoridation.) South Dakota legislators are considering a bill to set a maximum fluoride level in water, replacing an existing minimum requirement.
The rush of legislation comes after President Trump has suggested he may push to remove fluoride from drinking water, encouraged by Health and Human Services Secretary Robert F. Kennedy Jr. Kennedy, long a vaccine skeptic, has promoted controversial studies on fluoridation on social media — studies and claims that most health experts dismiss.
Supporters of the bills say they are ending the practice of government prescribing a medical treatment to their residents.
“I do not believe that the proper role of government is to dose people at a [level] that causes harm,” Utah Rep. Stephanie Gricius (R), the chief sponsor of her state’s soon-to-be law, told fellow lawmakers.
Stuart Cooper, executive director of the Fluoride Action Network, which opposes adding fluoride to water supplies, said new studies that show potential harms caused by fluoride — especially in young children and pregnant women — have spurred a renewed legislative interest in the last decade.
“There’s definitely a significant uptick” in fluoridation bills, Cooper told Pluribus News. “Legislators love to follow a herd path.”
Cooper said so many lawmakers are introducing fluoridation bans this year after a federal district court judge in California in September ordered the Environmental Protection Agency to regulate fluoride in drinking water after a study funded by the National Institutes of Health found high levels of fluoride could cause lower IQs in children.
Scientific groups such as the American Academy of Pediatrics have questioned the validity of the NIH study, which suggested that fluoridation could be harmful in doses that equal more than double the amount recommended by the U.S. Public Health Service.
Proponents of fluoridation point to repeated studies that show the dental benefits of fluoridation. Utah Rep. Jake Fitisemanu (D), who voted against his state’s ban and who works in public health, said the measure went too far to override local control.
“At the very least, local communities should have freedom to make local water supply determinations for themselves,” Fitisemanu said on the House floor.
At the federal level, the U.S. Public Health Service recommends a fluoride level of 0.7 milligrams per liter of water, or about three drops in a 55-gallon barrel. But that recommendation is not an enforceable standard.
Fourteen states have some form of mandate on the books requiring public water systems with more than a certain number of customers to add fluoride. Arkansas, the most recent state to add a mandate in 2011, requires systems serving more than 5,000 people to fluoridate water. California law applies to systems with at least 10,000 customers. Delaware law applies specifically to municipalities.
But in most states, existing law leaves decisions up to communities. About 1,500 communities have voted to end fluoridation in the last decade, Cooper said. In Florida, the cities of Longwood, Tavares, Palm Bay, Ormond Beach and Melbourne have all ended fluoridation after Ladapo’s advisory.
The trend does not exist entirely in one direction: Lawmakers in Connecticut, Hawaii, New Jersey and Tennessee have introduced bills this year to add fluoridation mandates. And proposed measures to prohibit fluoridation have died this year in North Dakota and Mississippi. A New Hampshire prohibition was reported unfavorably out of committee, though it is not formally dead.
Public health experts, including the American Dental Association and the American Public Health Association, support fluoridation. The CDC cites studies that show fluoridation reduces cavities by about 25%, and that fluoridation returns an estimated $20 for every dollar spent on treatment.
“Fluoridation is the ideal preventative measure for tooth decay,” said Myron Allukian, a past president of the American Public Health Association and a longtime dental director for the City of Boston. “It’s safe and it’s effective, and it has a great cost-benefit ratio.”
The practice of fluoridation began in 1945, when Grand Rapids, Mich., became the first city in America to add fluoride to the water. Scientists had found fluoride helps prevent dental decay and cavities.
In the subsequent decades, as fluoridation became more widespread, incidents of cavities and dental decay plummeted across America. The first widespread study in Grand Rapids found a 60% decline in dental problems among children who drank the water.
Today, more than 200 million Americans live in places that fluoridate their water.