Utah now prohibits state and local governments from adding fluoride to public water systems, becoming the first state in the nation to do so.
Gov. Spencer Cox signed House Bill 81 into law on March 27, and it went into effect on May 7. The legislation also bans political subdivisions from enacting or enforcing laws to override the law.
The American Dental Association, the nation’s largest dental organization, had urged Cox to veto the bill, emphasizing fluoridation’s cost-effectiveness in reducing tooth decay and its widespread support across the health care sector, in a February 25 letter.
Eighty-Year History
Fluoride, a naturally occurring compound present in groundwater, was found to help prevent tooth decay and cavities in the early 1900s. Grand Rapids, Michigan, became the first U.S. city to fluoridate its municipal water system, in 1945.
Fluoridation of water systems expanded throughout the United States, and by 2022, the Centers for Disease Control and Prevention estimated 72.3 percent of Americans connected to community water systems—or about 62.8 percent of the total U.S. population—were receiving fluoridated water.
Despite continued endorsement by the Centers for Disease Control and Prevention (CDC), debates over fluoride’s safety persist today.
In November 2024, Robert F. Kennedy Jr., now Health and Human Services Secretary, suggested removing fluoride from U.S. water systems, calling it a “dangerous neurotoxin.” In April of this year, Kennedy proposed ending federal recommendations for fluoridation.
Other states are considering legislation similar to Utah’s ban. Florida, Ohio, and South Carolina are exploring fluoride bans, and lawmakers in New Hampshire, North Dakota, and Tennessee have rejected such measures. A Kentucky bill to make fluoridation optional stalled in the state Senate.
‘Scaremongering Through Bad Science’
Anti-fluoride arguments are “scaremongering through bad science,” says John Dale Dunn, M.D., J.D., a Texas physician and policy advisor to The Heartland Institute. Dunn criticizes the use of the “linear no-threshold” model, which assumes even minimal exposure to a substance could be harmful, regardless of real-world exposure levels.
“They produce research that shows toxic effects at levels far higher than those found in fluoridated water,” said Dunn. “It’s nothing more than generating fear based on bad science.”
The benefits of fluoridation, particularly in reducing cavities, far outweigh any hypothetical risks at recommended levels, which are safe, says Dunn.
“There’s a reason fluoride is in the water,” said Dunn. “Yes, people can use fluoride toothpaste, but are we going to outlaw that too? The idea that fluoride is harmful at the levels used in water systems is simply not supported by credible evidence.”
Dunn attributes the suspicions about fluoride to the “precautionary principle,” which he says creates exaggerated public fears of substances such as fluoride and mercury.
“What you have to do is look at risk versus benefit,” said Dunn. “At recommended levels, there’s no risk—and fluoride has dramatically improved dental health in the United States.”
Issue of Local Control
Fluoridation decisions should be made at the community level, says Merrill Matthews, Ph.D., a columnist for The Hill.
“Voters and their elected representatives should decide,” said Matthews. “The closer the decision is to the people, the better, and if problems arise, communities can always reverse course.”
Transparency is critical, says Matthews.
“Cities that fluoridate should make water fluoridation levels publicly available online, including how those levels compare to CDC recommendations and the rationale for any differences,” said Matthews.
‘Toxicity Is Highly Unlikely’
Most dental professionals support water fluoridation because of its effectiveness in reducing tooth decay, particularly in children. While some people get fluoride from toothpaste or direct treatments, water fluoridation provides broad, consistent protection, says Matthews.
“Fluoride toxicity is highly unlikely at recommended levels,” said Matthews. “Nearly all studies that found problems were examining excessive levels far above what’s used in public systems.”
Fluoride is important for children’s dental health, with a study in Israel having found increased cavity rates after the country stopped water fluoridation, says Matthews.
The debate also represents a political divide on environmental health concerns.
“Liberals tend to be more concerned about toxins in food and the environment, while conservatives often argue that these fears are based on unrealistic exposure levels,” said Matthews.
Continuing Debate
Although high fluoride intake can be toxic, public health authorities say the levels used in U.S. water systems are both safe and beneficial. The CDC continues to list water fluoridation as one of the top 10 public health achievements of the twentieth century.
Similar debates over public exposure to metallic and nonmetallic elements such as fluoride have occurred regarding mercury and lead, says Dunn.
“If you’re loaded up with mercury, lead, or fluoride, it will cause nerve damage, but to get to that level of toxicity, you’ve got to be eating lead or getting some kind of wild exposure to a heavy metal that doesn’t exist in the normal environment,” said Dunn.
As Utah moves forward with its ban, the debate over fluoridation remains active at both the state and national levels. Supporters argue fluoridated water has helped reduce health disparities, while opponents call for more individual choice and greater scrutiny of government health mandates.
Kenneth Artz ([email protected]) writes from Tyler, Texas.
Editor’s note: On May 15, following Utah’s action. Florida Gov. Ron DeSantis signed a bill removing fluoride from the state’s list of approved additives in public water systems. The law goes into effect on July 1.
Artz has more than 20 years’ experience in nonprofit organizations, publishing, newspaper reporting, and public policy advocacy.
