What is Fluoride and Why is it So Controversial Right Now?
Recently, Secretary of Health and Human Services Robert F. Kennedy Jr. said that he would tell the Centers for Disease Control and Prevention (CDC) to stop recommending water fluoridation nationwide. He also said he was assembling a task force to study the issue. Additionally, the Environment Protection Agency (EPA), which sets the allowable safe levels of fluoride in water, said it would review information on the issue.
Importantly, this does not mean that communities must stop water fluoridation. However, it raises questions about why fluoridation is now being examined, and how it came to be one of the most successful public health campaigns in U.S. history.
At Health Care For All, we envision a day when everyone in Massachusetts has affordable and equitable access to the health care they need. To reach this goal we work to advance and defend improvements to multiple parts of our health care system, including our oral health system. To do this, HCFA is focused on not only oral health access, but also on prevention of oral disease and public health strategies that improve oral health outcomes for people across the Commonwealth. While fluoride is in the headlines, we want to provide background on the importance of water fluoridation and what it means for communities across the country.
Fluoride is a naturally occurring mineral that helps prevent cavities by strengthening the enamel on our teeth and is found in almost all water sources. Long before public health agencies began issuing guidance on its use, many communities were already experiencing the oral health benefits of fluoridated water due to naturally higher concentrations of the chemical. After discovering these higher concentrations over 120 years ago, scientists and oral health professionals conducted studies and discovered these communities had far lower levels of tooth decay than the national average. By 1942, researchers determined the clinically effective dose to help prevent tooth decay and restore enamel without causing side effects. Three years later, Grand Rapids, Michigan became the first city to add fluoride to its public water supply. As of 2022, over 209 million people in the US had access to drinking water containing optimal levels of fluoride.
Recently, questions about the safety of fluoride have reignited the discourse on community water fluoridation. While some point to studies that claim to show links between very high levels of fluoride and negative side effects, it’s important to note these studies looked at water sources (primarily in China, India and Iran) with much higher levels of naturally occurring fluoride than the CDC, the EPA and the World Health Organization recommend. In Massachusetts and across the country, when a community decides to add fluoride to their water, it is a carefully reviewed and monitored process to ensure that fluoride levels remain at .7 milligrams per liter. That level is enough to prevent decay but far lower than the amount found to cause negative side effects.
In the decades since community water fluoridation was widely adopted, the CDC has named it among the top ten greatest public health achievements in the US. They cite a 40-70% reduction in tooth decay among children and a 40-60% reduction in tooth loss in adults between 1945 and the late 1990’s. Today, drinking fluoridated water reduces cavities by 25% in both children and adults even when controlling for the prevalence of fluoride in products like toothpaste and mouthwash. The CDC estimates that providing optimally fluoridated water in the US for one year saves $6.5 billion in dental treatment costs.
This achievement is all the more meaningful given persistent health equity challenges shaping access to dental care and oral health outcomes. Nationally, cost barriers to dental care are higher than for other health care services, with Hispanic and low-income Americans facing the highest cost barriers. These health equity barriers stretch beyond simple affordability concerns. 1 in 6 Black adults report having lost 6 or more teeth to dental disease and low-income children are 3 times more likely to have untreated cavities. Additionally, people with disabilities, and adults with less than a high school education are more likely to have to rely on costly emergency room visits for preventable and painful dental issues. Given these barriers to care, the baseline protection that water fluoridation provides is especially important in protecting oral health in these underserved communities.
Oral health is essential to our overall health, with implications for diabetes management, cardiac health and pregnancy outcomes, as well as emotional wellbeing with direct connections to self-confidence, job and school performance. Limiting the use of fluoride in public drinking water would have a detrimental effect on overall health and would exacerbate these health disparities. That is why HCFA strongly supports continued water fluoridation. When access to dental care is deeply unequal, more people need costly dental treatments, with low-income children, people of color and people with disabilities disproportionately bearing the consequences. As an organization committed to health equity, Health Care For All will continue to support community water fluoridation as a necessary part of our oral health system.
Grace Coughlin is a Policy Manager at Health Care For All.
