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US states reverse long-standing fluoride policies
Utah and Florida have become the first US states to ban fluoride additives in public water supplies this year, marking a shift in a decades-old public health practice. The moves follow growing opposition from political figures and wellness advocates who question the mineral's safety and necessity.
Political and public health debate intensifies
In March 2025, Utah enacted legislation prohibiting fluoride in municipal water systems. Florida followed in May, with Governor Ron DeSantis signing a bill that bans "certain additives," including fluoride-a practice dating back to 1949 in the state. The decisions align with statements from US Health and Human Services Secretary Robert F. Kennedy Jr., who has directed federal agencies to review the scientific evidence on fluoride's health risks.
Wellness influencer Calley Means, now a government adviser, has called water fluoridation an "attack on lower-income children" and urged parents to discard fluoride toothpaste. His sister, Casey Means, nominated by Donald Trump as US Surgeon General, shares similar views.
Scientific consensus on dental benefits
Fluoride has been added to drinking water since 1945, after researchers observed lower tooth decay rates in areas with naturally high fluoride levels. Today, about 25 countries-including parts of the UK, Ireland, Spain, and Brazil-fluoridate water, reaching over 400 million people globally. In the US, 63% of the population (209 million people) receive fluoridated water, though for 12 million, the mineral occurs naturally.
A 2016 Australian review found water fluoridation reduced childhood tooth decay by 35%, while a 2022 English report showed similar benefits for 3-year-olds. The effect is most pronounced in deprived communities with limited access to dental care or fluoride toothpaste.
"Community water fluoridation closes the gap between poor and well-off people. It reaches everyone, reducing health inequality,"
Vida Zohoori, Professor of Public Health, Teesside University
Safety concerns and global disparities
Critics cite studies linking high fluoride exposure to lower IQ scores in children, though reviews note these effects occur at levels twice the US recommended limit (0.7 mg/L). The World Health Organization (WHO) caps fluoride in drinking water at 1.5 mg/L to avoid dental fluorosis (white spots on teeth) or skeletal fluorosis (a bone condition).
Most countries do not fluoridate water, but reasons vary. In Europe, only Ireland, parts of the UK, and Spain maintain the practice. Eleven EU nations abandoned it due to public opposition, logistical barriers, or sufficient fluoride from other sources (e.g., fluoridated salt or milk). None cited safety concerns as the primary reason.
Switzerland, for example, has fluoridated salt since 1955, while Thailand runs the world's largest milk fluoridation program, providing fortified milk to over 1 million schoolchildren daily. A 2012 review found Asian countries often avoid water fluoridation due to high natural fluoride levels (e.g., India), cost barriers (e.g., Nepal), or alternative delivery methods.
Reversals and regional contrasts
Some regions have reversed fluoridation bans after observing negative outcomes. Calgary, Canada, reinstated fluoride in 2025 following a rise in tooth decay after its 2011 removal. Japan, which does not fluoridate water, relies on school-based fluoride mouth rinses, yet a 2023 study found 40% of 7-year-olds required dental treatment for cavities-a high rate given the country's low sugar consumption.
Europe, despite low fluoridation rates, has the highest prevalence of oral diseases globally, according to a 2023 WHO report. Dental caries cost EU countries more than Alzheimer's, cancer, or stroke, ranking as the third-costliest health issue after diabetes and cardiovascular disease.
Future of fluoridation
As US states reconsider fluoride policies, public health experts warn of widening disparities. "Removing fluoride from water will disproportionately harm disadvantaged communities," says Mary Rose Sweeney of the Royal College of Surgeons in Ireland. Meanwhile, England's government plans to expand fluoridation in high-decay areas like Middlesbrough, where natural fluoride levels are low.
The debate highlights tensions between individual choice, scientific consensus, and equitable health outcomes. While alternatives like fluoridated salt or milk exist, experts argue water remains the most effective and inclusive delivery method.
