The US Department of Health and Human Services said Monday that it is reconvening the Community Preventive Services Task Force, an independent panel of public health and prevention experts, “to study and make a new recommendation on fluoride.”
HHS Secretary Robert F. Kennedy Jr. also told the Associated Press on Monday that he will soon tell the US Centers for Disease Control and Prevention to stop recommending fluoridation for drinking water in communities.
And US Environmental Protection Agency Administrator Lee Zeldin announced Monday that the EPA will expeditiously review scientific information on the “potential health risks of fluoride in drinking water.”
“Without prejudging any outcomes, when this evaluation is completed, we will have an updated foundational scientific evaluation that will inform the agency’s future steps,” he said in a statement.
Although the CDC makes recommendations, it is the EPA that sets the limits on what is allowed in water and makes recommendations under the Safe Drinking Water Act.
On Monday, Kennedy and Zeldin visited Utah, which in March banned municipal drinking water systems from adding fluoride, starting in May.
“I think it’s a moral imperative that we all believe in freedom of choice in this country,” Kennedy said. “It is one of the bedrock principles of our democracy, and the government shouldn’t be making decisions, intimate decisions about our own lives.”
Lawmakers in states including Ohio, South Carolina and Florida have also proposed restrictions on fluoridated water.
“As dentists, we see the direct consequences fluoride removal has on our patients and it’s a real tragedy when policymakers’ decisions hurt vulnerable kids and adults in the long term,” Dr. Brett Kessler, president of the American Dental Association, said in a statement Monday. “Blindly calling for a ban on fluoridated water hurts people, costs money, and will ultimately harm our economy. We see on a daily basis the benefits of fluoride, from both drinking fluoridated water and topically in products like fluoride toothpaste and other dental products, so we know the need for both exists.”
Dr. Darren Chamberlain, a pediatric dentist who is on the board of directors for the Utah Dental Association, said he operated Monday morning on patients who had 12 and 14 cavities.
“I’m nervous that that’s going to be the future in Utah, and I did this at Medicaid’s expense, and it was thousands of dollars to be able to do that. So I hope that they have the funds to be able to help out children, because we will see more of these circumstances,” he said. “I feel for the children that are going to be affected by this.”
Fluoridation of public water systems has long been considered one of the most successful public health advances of the 20th century. Municipalities across the country have been adding fluoride to water since about the 1940s, after scientists noticed that people who got water in places with high rates of naturally occurring fluoride had fewer cavities.
The CDC, the American Academy of Pediatrics and the American Dental Association support the use of fluoride as an effective and safe way to maintain dental health.
Adding this naturally occurring mineral to drinking water is the most cost-effective way to strengthen teeth, the CDC says, protecting them from normal wear and tear as well as cavities, particularly among children. In some cases, it may be the only oral health protection a family has access to if they can’t afford regular trips to a dentist.
The CDC calls cavities the most common chronic disease of childhood in the United States, and Kennedy has said that chronic conditions are his primary concern. But the HHS secretary has also said he wants the country to remove fluoride from its water systems because of concerns about its health risks.
On the campaign trail last fall, Kennedy called fluoride “industrial waste” and claimed that exposure has resulted in a wide variety of health problems, including cancer. The American Cancer Society and the CDC have disagreed, pointing out that most studies of people living in areas with fluoridated water did not find an association between fluoride and cancer risk, although many also call for additional research.
Zeldin cited Kennedy’s advocacy on fluoride as one of the main reasons he was calling for the scientific review.
“As soon as I was nominated by President Trump as administrator of the EPA, the secretary instantly reached out to start talking about issues that he is so passionate about, and number one on that list was fluoride,” Zeldin said Monday.
The newly announced scientific review that the EPA will conduct along with HHS is centered around a report that the National Toxicology Program released in August, concluding that higher levels of fluoride – above 1.5 milligrams per liter – are linked to lowered IQ in children.
“These studies used research from areas outside of the US with high naturally occurring fluoride and did not find an association between fluoride and IQ at low levels,” the American Dental Association said in its statement. “The authors of the report clearly state that their findings do not pertain to the practice of fluoridation in the U.S. and Canada with levels at 0.7 mg/L.”
The EPA has committed to a “thorough review of these findings and additional peer reviewed studies,” the agency said Monday.
In September, a federal judge ordered the EPA to take additional steps to regulate fluoride because a handful of other studies have found a possible link between exposure to high levels of fluoride and children’s intellectual development.
A separate recent report from the Cochrane Collaboration, an independent group that systematically analyzes scientific research, found just a slight benefit in adding fluoride to tap water, leading to slightly fewer cavities in children’s baby teeth. It tempers the scale of the positive effects of adding fluoride to public water.
Fluoride is used in public drinking water systems supplied to three-quarters of Americans, according to the CDC.
The American Dental Association says that fluoridation continues to be effective in reducing dental decay by at least 25% in kids and adults, even when there are alternative ways for people to get it, such as toothpaste.
In Utah, lawmakers and voters have gone back and forth on the benefits of adding fluoride to water. In 1976, voters passed a ballot initiative that prohibited the State Board of Health from mandating the addition of fluoride or other medicines to public water supplies and required local voters to pass an initiative to add them.
Health concerns weren’t the only reason for the ban, however; rather, some voters believed claims that fluoridation was part of a communist plot against the country.
In 2000, Salt Lake County voters were the first in Utah to vote to add fluoride to their water. Fluoridation began in 2003, and other counties soon followed, but the number of people who drink fluoridated water in Utah is still low compared with other states.
In 2022, the CDC found that only about 44% of Utah residents had access to fluoridated water systems, with Utah ranking 44th among US states. By comparison, all drinking water in the in Washington area is fluoridated. In Kentucky, it is for 99.7% of the population.
More recently, some anti-fluoride advocates in Utah have said that adding fluoride to water was too expensive, while others argued about its effects on health. The American Dental Association sent letters to lawmakers to protest the ban, and some municipalities also fought it.
Salt Lake County has argued that removing fluoride from the drinking water will be expensive for local families.
The department said it is preparing educational information to let families know that when fluoride is removed from their water, they will need to provide fluoride supplements for their children to replace the benefits.
The American Academy of Pediatric Dentistry recommends that children between the ages of 6 months and 16 years who are at high risk of cavities get some form of fluoride every day.
Although water fluoridation is thought to save an average of $32 per person a year by avoiding the need for cavity treatment, Salt Lake County said, having to add supplements to a child’s daily routine will collectively cost families at least $284,000 – and not all families will be able to afford the supplements.
Ending fluoridation has had negative effects in some places. A 2019 study in Juneau, Alaska, found that children without access to fluoride in their drinking water also had more dental-related procedures.
Calgary, Alberta, stopped putting fluoride in its water in 2011, and a study found that children there had more cavities than those in cities that kept fluoride. Calgary will resume fluoridation this year.
“Maybe we should be happy at some level that the EPA is looking into this, because we definitely know from the 80 years of fluoridating water in the United States that it is effective,” Chamberlain said. “In practice, we definitely see a significant difference between people who live in fluoridated and nonfluoridated communities.”