Removing fluoride from public water sources could have detrimental negative effects on the dental industry and public health, experts say.
The effects of water fluoridation have been heavily debated in recent months after a National Toxicology Program concluded that higher levels of fluoride exposure are associated with lower IQ in children. The NTP report has been heavily contested by several local and national organizations, with many citing methodological flaws such as insufficient sample sizes.
Robert Kennedy Jr., President-elect Donald Trump's pick for secretary of Health and Human Services, also said Mr. Trump would aim to remove fluoride from public water sources once he is in office.
Mr. Kennedy claimed in a post on X that fluoride is associated with arthritis, bone fractures, bone cancer, IQ loss, neurodevelopmental disorders and thyroid disease, but did not cite any evidence or studies.
Six dentists recently spoke with Becker's to discuss the national debate on water fluoridation, and the impact ending water fluoridation could have on patients.
Editor's note: This response was lightly edited for length and clarity.
Mert Aksu, DDS. Professor and Dean at the University of Detroit Mercy School of Dentistry and president of the Michigan Oral Health Coalition: While some may view debates as contentious, I believe they serve a valuable purpose by encouraging us to critically evaluate existing practices, review new research, and reaffirm — or adapt — our approaches based on evidence. Since 1945, we have seen a dramatic decrease in dental disease due to community water fluoridation.
The scientific research overwhelmingly supports water fluoridation as a safe and effective public health measure. Peer-reviewed studies consistently demonstrate that fluoridation significantly reduces the prevalence of tooth decay by at least 25% across all age groups, with particular benefits for children and underserved populations who may lack access to other forms of dental care. It is a powerful tool in bridging health disparities.
If water fluoridation were discontinued, the short-term impact would likely include increased tooth decay and tooth-related pain, particularly among children and vulnerable populations. Over the long term, we would see a cascading effect on overall public health, including:
- Increased healthcare costs due to a rise in preventable dental conditions.
- Greater inequities in oral health outcomes, disproportionately affecting low-income and rural communities.
- Potential negative effects on systemic health, as untreated dental disease is linked to chronic conditions such as diabetes and cardiovascular disease.
- Increased risk of premature tooth loss and resultant impact on nutrition.
Community water fluoridation is not just about individual dental health — it is a public health measure that protects the collective wellbeing of society. Removing this intervention would undermine decades of progress in improving oral health outcomes.
After reviewing the current research, I remain steadfast in my support for community water fluoridation as a vital public health measure. While the debate surrounding it is not inherently harmful, the evidence remains clear: fluoridation at the recommended levels is the most effective, equitable and far-reaching strategy we have to prevent tooth decay.
Corey Anderson, DDS. Affordable Dentures & Implants (Bridgeport, W.V.): From a public health perspective, continuing fluoridation will save money in dental care expenditures 14 times greater than the cost of the fluoridation. No dentist wants to perform avoidable procedures on patients. It is known that teeth are less susceptible to decay with fluoridation. The irreversible harm that comes from stopping fluoridation is completely unnecessary. Ending fluoridation benefits no one in the long run, and will increase toothlessness and diminish quality of life for patients.
Jeremy Burgin, DDS. Burgin Dentistry (Clovis, N.M.): There have been a lot of publications concerning the benefits of fluoride. I treated a town in Missouri back in 2008 that had removed fluoride from their drinking water, and I was putting complete dentures into girls in their 20s. It was very tragic. I believe the short-term effect will be rampant decay in the population. The long-term effect I believe we will see is the quality/density of people's bony structures. The human skeleton itself will become more brittle and subject to more occurrences of breakage and fracture.
Lakshay Goyal, DDS. Oakland Park (Fla.) Family Dental: I believe there is some value to questioning our long-held beliefs. Through lab and demographic studies, we should be able to justify and clearly communicate to the public why it is or is not worth adding chemicals to the waterways of our neighborhoods and the risks, benefits and alternatives.
Even as a dentist, I don't have a clear position on this. Meaning, there's no way the average citizen should know where to stand. Shouting the public down is definitely not the answer. The onus is on public health officials and the dental community to sway this discussion.
Frankly, I'm not convinced that with current daily fluoride exposure and availability we need to alter our community water. At minimum, it is worth a discussion.
Misako Hirota, DMD. Hirota Dental (National City, Calif.): It is astonishing that peer reviewed evidence is discounted in this day and age. Most of the cons being presented are based on levels of fluoride that are many times above what is being used in fluoridated communities. Yes, fluoride is a toxin but at very high levels, which realistically we are not exposed to by drinking water. The sad truth is that most people do not drink tap water. Most Americans drink bottled water that is not fluoridated. The highest impact of this proposed policy will be in lower income areas that cannot afford bottled water and drink tap water. These are also the communities that have less access to care and will suffer the most.
Angela Verma, DDS. East Village Smiles (New York City): I think the topic of fluoridation is important. Moreover, I think the public and providers have shifted to a more evidence-based healthcare approach to help make their healthcare decisions. The current study and recommendation by the [National Institute of Dental and Craniofacial Research] advocates for more testing. Although this may make a lot of people uncomfortable because it's challenging a belief, I believe it’s not a bad idea to review.
If fluoride is removed from the water, patients can still have over-the-counter fluoride rinses that are not swallowed and toothpastes to help give teeth the fluoride benefits. In addition, pediatricians often recommend chewable vitamins for younger children that contain fluoride to help with their growing teeth.
What result that will have in the population will be hard to predict because dental cavities can also be influenced by diet, hygiene, genetics, medications and even other systemic health issues. Fluoride will not be the only factor contributing to dental cavities or the health of the enamel.
Overall, the fluoride debate is a good question, but may not have the clear cut answer we may be seeking to put this debate to rest.