FLORIDA and Utah are the first American states to ban fluoride in public water systems.
Fluoride was not specifically mentioned although “the use of certain additives in a water system” will be prohibited. Instead, “fluoride” was removed from Florida’s legal definition of acceptable “water quality additives.”
State representatives who voted against the bill said fluoride is important for dental health.
Community fluoridation was first introduced in the United States in 1945 – in Grand Rapids, Michigan.
By the 1950s, the US government and the American Dental Association (ADA) acknowledged that water fluoridation lowered the incidence of tooth decay. Today, it remains for municipal governments, city councils or local water authorities to decide whether to put fluoride in community drinking water.
The US Centers for Disease Control and Prevention (CDC) considers fluoridation of drinking water as one of the 10 great public health achievements of the 20th century because of how much it has improved oral health care among Americans.
The CDC says that community fluoridation is behind the 25 percent reduction in cavities among children in America. This is important as cavities or tooth decay is painful and may affect speaking – as well as eating and thus nutrition. Cavities may also cause tooth loss or infection, conditions that that can spread to the rest of the body and can lead to serious illness or even death.
The ADA continues to recommend community water fluoridation to help prevent tooth decay, citing studies showing that community water fluoridation reduces cavities by more than 25 percent among both children and adults even when fluoride from toothpaste is available.
On the other hand, Florida Gov. Ron DeSantis, who signed the ban on May 15 and which will take effect on July 1, called fluoride in public water systems a “forced medication.”
A similar ban approved in Utah in late March went into effect last May 7. Other states (Kentucky and Nebraska) are looking at similar measures.
Fluoride is a naturally occurring mineral found in trace amounts in soil, plants, food, as well as water. It can repair and prevent damage to teeth caused by bacteria in the mouth after eating or drinking, according to the CDC.
Fluoride strengthens enamel, the hard outer layer of teeth, and makes it more resistant to acid from bacteria and sugary foods. Fluoride replaces the minerals dissolved by acid produced by bacteria in the mouth and which weaken the tooth’s surface. In effect, cavities and tooth decay are prevented.
The natural fluoride found in almost all water, however, is too low to make much of a protection to teeth, according to the CDC which estimates that in 2024 nearly three-quarters of Americans have access to fluoridated drinking water.
In 1962, the US Public Health Service (PHS) recommended the addition of fluoride to community drinking water. It noted what researchers observed in the 1930s: because fluoride occurred more naturally in certain communities, these communities had significantly less incidence of dental decay.
An optimal fluoride concentration of 0.7 milligrams per liter (mg/L) of water is recommended by the PHS which is composed of agencies of the U.S. Department of Health and Human Services (HHS) which manages public health.
However, according to the World Health Organization (WHO), long-term exposure to fluoride levels above 1.5 mg/L in drinking water can lead to health problems. According to the United Nations health agency, prolonged exposure to high concentrations of fluoride may cause tooth enamel and skeletal fluorosis, a serious condition that causes bone weakness and stiffness and pain in joints.
Conspiracy theorists argue that fluoride does not improve water quality or dental health, a stand supported in early April when Robert F. Kennedy Jr., a non-doctor who heads the HHS of which the CDC is a part of. He has called fluoride an “industrial waste”.
In April he reduced by 10,000 the manpower of the CDC’s oral health division which, among other programs, promotes community water fluoridation.
Mr. Kennedy, a lawyer, has no authority to ban fluoride but can tell the CDC to stop recommending it. The US Environmental Protection Agency (EPA) is responsible for fluoride limits (4 mg/l) under the US Safe Drinking Water Act. The EPA plans to review research on the health effects of fluoride as a basis to regulate its presence in drinking water.
In the United Stares, even the safety of fluoride levels in toothpaste is now being challenged.
Much of the fluoridated water in America is composed of fluorosilicic acid from phosphate rock. According to the EPA, the US produced about 29 million kilograms (32,000 tons) of fluorosilicic acid in 2019.
Water fluoridation is not required in the US. As of 2022, seven of 10 Americans with community water systems (and as much as 100 percent in Washington, DC) had access to fluoridated drinking water. About half of these water systems have fluoride concentration within recommended levels.
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Dr. Joseph D. Lim, Ed. D., is the former Associate Dean of the College of Dentistry, University of the East; former Dean, College of Dentistry, National University; Past President and Honorary Fellow of the Asian Oral Implant Academy; Honorary Fellow of the Japan College of Oral Implantologists; Honorary Life Member of the Thai Association of Dental Implantology; and Founding Chairman of the Philippine College of Oral Implantologists. For questions on dental health, e-mail jdlim2008@gmail.com or text 0917-8591515.
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Dr. Kenneth Lester Lim, BS-MMG, DDM, MSc-OI, graduated Doctor of Dental Medicine, University of the Philippines, College of Dentistry, Manila, 2011; Bachelor of Science in Marketing Management, De la Salle University, Manila, 2002; and Master of Science (MSc.) in Oral Implantology, Goethe University, Frankfurt, Germany, 2019. He is an Associate Professor; Fellow, International Congress of Oral Implantologists; and Fellow, Philippine College of Oral Implantologists. For questions on dental health, e-mail limdentalcenter@gmail.com/PN
