For nearly 80 years, fluoride has been added to public drinking water to help fight tooth decay — a practice once hailed as one of the top public health achievements of the 20th century. But today, a growing wave of legislative changes is shaking up that long-standing tradition, igniting debate among health professionals, policymakers, and the public alike. 

States Taking a Stand 

In a groundbreaking move, Utah became the first U.S. state to ban fluoride in public drinking water earlier this year. Governor Spencer Cox signed legislation preventing cities and communities from adding fluoride to their water supply, effectively halting local control on the matter. 

Hot on Utah’s heels, Florida lawmakers passed a bill that indirectly bans fluoride by restricting certain water additives — and it now awaits Governor Ron DeSantis’ signature. Meanwhile, Miami-Dade County voted to remove fluoride, though Mayor Daniella Levine Cava has hinted she may veto the decision. 

National Policy in the Spotlight 

The debate has also reached the federal stage. U.S. Health Secretary Robert F. Kennedy Jr. recently announced plans to direct the CDC to stop recommending community water fluoridation nationwide. Additionally, the Environmental Protection Agency (EPA) is currently reviewing new scientific evidence on potential health risks linked to fluoride exposure. 

What We Know: The Science Behind Fluoride 

Fluoride has been part of U.S. water supplies since 1945 to help strengthen tooth enamel and prevent cavities. According to the CDC, community water fluoridation ranks among the top ten public health achievements of the past century. 

✅ Key Benefits: 

• Reduces cavities, especially in children. 

• Helps protect vulnerable populations, including low-income and rural communities with limited dental access. 

• Offers huge cost savings: Removing fluoride could result in 25.4 million more cavities over five years, with an estimated $9.8 billion (about $30 per person) in added dental costs, according to a new JAMA study released on May 30. 

In fact, the American Dental Association (ADA) reaffirmed its strong support for fluoridation, emphasizing the health and financial consequences of discontinuation. Studies show that after Juneau, Alaska stopped fluoridating its water, children on Medicaid saw a 47% increase in cavity-related treatment costs over nine years. In Calgary, Canada, ending fluoridation led to a 78% jump in young children requiring general anesthesia for severe dental decay — prompting Calgary to reinstate fluoridation starting this June. 

Arguments For and Against 

💬 Pro-removal advocates argue that fluoride is unnecessary for improving water quality and eliminating it could reduce municipal costs. Some critics raise concerns about potential health risks, including claims that fluoride is a neurotoxin. 

💬 Pro-fluoridation supporters — including most dentists and public health officials — warn that removing fluoride will disproportionately harm lower-income populations who rely on fluoridated water to maintain dental health. 

Common Myths (and the Facts) 

Let’s clear up some of the most common misconceptions: 

❌ “Fluoride is unnatural.” 
✅ Fluoride is a naturally occurring mineral found in water, soil, and rocks. 

❌ “Fluoride is toxic.” 
✅ At controlled levels, fluoride is safe and beneficial. Excessive doses — like anything — can be harmful but regulated drinking water levels are well below danger thresholds. 

❌ “Fluoride causes cancer or autism.” 
✅ Extensive research has found no credible link between fluoride and cancer, autism, or other chronic illnesses. 

❌ “Fluoride lowers IQ.” 
✅ Some studies raise concerns, but they involve fluoride levels far higher than what’s present in U.S. water supplies. 

❌ “Fluoride is medication or a waste product.” 
✅ Fluoride is a mineral, not a drug — similar to how iodine is added to salt or vitamin D to milk — and the fluoride used in water treatment is purified and safe. 

For Dental Patients Who Decline Fluoride 

When patients refuse fluoride treatments, it’s critical to respect their choice while still offering meaningful, evidence-based alternatives. Here’s how dental professionals can respond: 

⭐ Lead with empathy and education: 

• Acknowledge concerns: “I understand you have reservations about fluoride. Could you share what specifically worries you?” 

• Provide gentle, science-backed explanations on how fluoride works and its safety record. 

⭐ Offer alternatives to reduce caries risk: 

✅ Xylitol gum or mints (3–5 times daily to inhibit cavity-causing bacteria). 

✅ Calcium-phosphate remineralizing agents (like MI Paste or CLIN Pro 5000 fluoride free options). 

✅ Hydroxyapatite toothpaste (a biomimetic, fluoride-free option backed by emerging research; brands include Apagard, Boka, and RiseWell). 

✅ Dietary counseling (reduce sugar/acid frequency; rinse with water after meals). 

✅ Enhanced home care (consistent brushing and interdental cleaning). 

✅ More frequent dental visits (every 3–4 months for higher-risk patients). 

⭐ Document and maintain trust: 
Record the patient’s fluoride refusal and the education provided. Keep the door open: “We’ll keep monitoring your teeth closely. If you ever want to revisit fluoride options, I’m happy to discuss it anytime.” 

What’s Next? 

With more cities and states reconsidering fluoridation, the national conversation around fluoride is only heating up. Some view these changes as a victory for health autonomy and local control; others warn of long-term dental health consequences, especially for society’s most vulnerable. 

As the fluoride debate unfolds, one thing is clear: the decisions made today will shape the oral health landscape for generations to come. 

© Blog content courtesy of Lisa Turner. All rights reserved.