Study Estimates Billions Needed to Remove Fluoride from Public Water

Removing fluoride from public water systems could lead to a huge increase in dental decay and cost billions of dollars, a recent study suggests. If all 50 states were to eliminate fluoride, children might see 25.4 million more decayed teeth over the next five years. The study, published in JAMA Health Forum, highlights that this issue would hit publicly insured and uninsured kids the hardest compared to those with private dental insurance.

Over a decade, the projected number of decayed teeth could rise to 53.8 million, costing a whopping $19.4 billion. The research utilized data from the National Health and Nutrition Examination Survey, involving 8,484 participants. While it’s noted that too much fluoride can cause tooth discoloration and act as a neurotoxin at high levels, the benefits of controlled fluoride use are emphasized.

The study also referenced a monograph by the U.S. National Toxicology Program, which pointed out neurotoxic effects in water with high fluoride levels. However, it found no significant cognitive issues at levels below 1.5 parts per million, which is more than twice the recommended amount by the CDC. This comes as a backdrop to Health Secretary Robert F. Kennedy Jr.’s push to remove fluoride from public water systems.

Critics, like the American Dental Association, argue against removing fluoride, citing potential harm to vulnerable populations. ADA President Brett Kessler expressed concerns over the economic and health repercussions of such a move. The JAMA study concluded that despite the risks of excessive fluoride, fluoridation at safe levels offers numerous benefits.

Calgary, Alberta serves as a case study, having added fluoride to its water in 1991, only to remove it in 2011 due to public council decisions. After an increase in cavities, a public vote in 2021 led to the decision to reintroduce fluoride by the end of June. This reversal required significant infrastructure upgrades costing $28.1 million.

The city’s experience showed that after fluoride removal, Calgary children had more cavities compared to kids in Edmonton, where fluoridation remained constant. A University of Calgary study supported these findings, demonstrating the negative impact on oral health. Calgary’s decision to restore fluoride reflects a broader understanding of its importance.

Utah recently made headlines as the first state to ban fluoride in public drinking water, a move that became effective in May 2025. Secretary Kennedy has encouraged other states to follow Utah’s example, stirring debate across the nation. The CDC reported that about 72% of U.S. municipal water systems provided fluoridated water in 2022.

Currently, laws in at least 12 states mandate fluoridation in communities of a certain size, including states like California and Georgia. Meanwhile, legislation to prohibit or repeal fluoride addition has been introduced in at least 12 states. Florida joined Utah in pioneering such legislation, sparking ongoing discussions about public health priorities.

Kennedy’s stance has drawn both support and criticism, reflecting a divide in public opinion on fluoride. Proponents of fluoridation argue it’s a cost-effective public health measure that prevents dental issues. Meanwhile, opponents cite potential health risks and advocate for individual choice in water treatment.

The debate over fluoride in water echoes larger discussions about public health interventions and individual freedoms. While some see fluoride as a necessary preventive measure, others view it as an unwelcome imposition. This issue continues to be a hot topic in state legislatures across the country.

As states navigate these decisions, the balance between public health benefits and potential risks remains central. For many, the conversation is about more than just teeth; it’s about autonomy and government intervention. As more studies emerge, these discussions are likely to intensify, with no easy resolution in sight.