Driving through downtown Dallas, you might see a striking banner hanging at the U-turn bridge, near the Walnut Hill exit on Central Expressway (US 75): “Stop Fluoridation!” Below it, other banners demand action and warn of supposed dangers.
It’s not the first time fluoride has been at the center of public debate.
Since 1951, fluoride has been added to community water supplies in many countries to prevent tooth decay. Fluoridation started as an observation, then an idea that ended as a scientific revolution 50 years later.
Fluoridation is the controlled careful addition of a precise amount of fluoride to community water systems to enhance dental health, ensuring it remains safe without causing systemic health side effects.
The practice has been hailed as one of the “10 greatest public health achievements of the 20th century.”
But with Robert F. Kennedy Jr, a vocal opponent of fluoridation of water supplies, being tapped by President-elect Donald Trump to lead the Department of Health and Human Services, this progress is under threat.
I am a clinical professor specializing in caries management, with over 30 years of experience in preventing and treating early decay. In my view, it is crucial to rely on evidence-based practices and research that have consistently shown fluoride to be a cornerstone of dental health, benefiting millions without adverse effects.
Fluoride in the water supply
Fluoride is a naturally occurring mineral found in water, soil and even certain foods. Its role in oral health was first recognized in the early 20th century when researchers observed lower rates of tooth decay in communities with naturally high levels of fluoride in their water.
In 1945, Grand Rapids, Michigan, became the first city in the world to intentionally fluoridate its water supply. This decision came after thorough discussions with Dr H Trendley Dean, head of the dental hygiene unit at the National Institutes of Health at the time, and other public health organizations. The Michigan Department of Health approved adding fluoride to the public water supply the following year.
The city was chosen due to its low natural fluoride levels, a large population of school-age children, and proximity to Muskegon, which served as a control city. After 11 years, the results were remarkable: Cavity rates among children in Grand Rapids born after fluoridation began dropped by over 60%. This scientific breakthrough transformed dental care, turning tooth decay into a preventable condition for the first time in history.
By 2008, over 72% of the U.S. population – over 200 million Americans – using public water systems had access to fluoridated water.
This scientific breakthrough transformed dental care, turning tooth decay into a preventable condition for the first time in history.
Fluoride is naturally present in most water sources, but typically at concentrations too low to prevent tooth decay. By adjusting the fluoride level to the recommended 0.7 milligrams per liter, equivalent to about three drops in a 55-gallon barrel, it becomes sufficient to strengthen tooth enamel.
Benefits of fluoride for tooth health
The science is simple: Fluoride strengthens tooth enamel, the protective outer layer of teeth, by promoting remineralization. It also makes teeth more resistant to the acids produced by bacteria in the mouth. This helps prevent cavities, a problem that remains widespread even in modern societies.
Fluoridated water has been extensively studied, and its benefits are well documented. According to the Centers for Disease Control and Prevention, water fluoridation reduces cavities by about 25% across all age groups. It’s a public health measure that works passively – every sip of water helps protect your teeth, without requiring you to change your behavior.
This is especially important for vulnerable populations. Low-income communities often face barriers to accessing dental care or fluoride products like toothpaste. By fluoridating water, communities provide a safety net, ensuring that everyone benefits regardless of their circumstances.
Economically, it’s a smart investment. Research shows that for every dollar spent on fluoridation, communities save about $20 in dental treatment costs. These savings come from fewer fillings, extractions and emergency visits – expenses that disproportionately affect low-income communities.
Opposition to fluoridation
Despite its benefits, water fluoridation is not without controversy. Opponents often argue that it infringes on personal choice – after all, most people don’t get to opt out of drinking community water. Others raise concerns about potential health risks, such as fluorosis, bone issues or thyroid problems.
Fluorosis, a condition caused by excessive fluoride exposure during childhood, is often cited as a reason for alarm. However, in most cases, it manifests as mild white spots on teeth and is not harmful. Severe fluorosis is rare in areas with regulated fluoride levels.
What about other health risks? Decades of research, including large-scale reviews by expert panels from around the world as well as the World Health Organization, have found no credible evidence linking fluoridation to serious health problems when fluoride levels are kept within recommended limits. In fact, the fluoride concentration in drinking water is carefully monitored to balance safety and effectiveness.
The CDC oversees the monitoring of fluoride levels in community water systems across the United States. Meanwhile, the Environmental Protection Agency establishes a safety standard of 2 milligrams per liter to prevent mild or moderate dental fluorosis.
Still, the debate continues, fueled by misinformation and mistrust in public health initiatives.
It’s important to separate legitimate concerns from unfounded claims and rely on the overwhelming body of evidence supporting fluoridation’s safety.
Fluoride alternatives
For those who prefer to avoid fluoride, there are alternatives to consider. But they come with challenges.
Fluoride-free toothpaste is one option, but it is less effective at preventing cavities compared with fluoride-containing products. Calcium-based treatments, like hydroxyapatite toothpaste, are gaining popularity as a fluoride alternative, though research on their effectiveness is still limited.
Diet plays a crucial role too. Cutting back on sugary snacks and drinks can significantly reduce the risk of cavities. Incorporating foods like crunchy vegetables, cheese and yogurt into your diet can help promote oral health by stimulating saliva production and providing essential nutrients that strengthen tooth enamel.
However, these lifestyle changes require consistent effort and education – something not all people or communities have access to.
Community programs like dental sealant initiatives can also help, especially for children. Sealants are thin coatings applied to the chewing surfaces of teeth, preventing decay in high-risk areas. While effective, these programs are more resource-intensive and can’t replicate the broad, passive benefits of water fluoridation.
Ultimately, alternatives exist, but they place a greater burden on people and might not address the needs of the most vulnerable populations.
Should fluoridation be a personal choice?
The argument that water fluoridation takes away personal choice is one of the most persuasive stances against its use. Why not leave fluoride in toothpaste and mouthwash, giving people the freedom to use it or not, some argue.
This perspective is understandable, but it overlooks the broader goals of public health. Fluoridation is like adding iodine to salt or vitamin D to milk. These are measures that prevent widespread health issues in a simple, cost-effective way. Such interventions aren’t about imposing choices; they’re about providing a baseline of protection for everyone.
Without fluoridated water, low-income communities would bear the brunt of increased dental disease. Children, in particular, would suffer more cavities, leading to pain, missed school days and costly treatments. Public health policies aim to prevent these outcomes while balancing individual freedoms with collective well-being.
For those who wish to avoid fluoride, alternatives like bottled or filtered water are available. At the same time, policymakers should continue to ensure that fluoridation levels are safe and effective, addressing concerns transparently to build trust.
As debates about fluoride continue, the main question is how to best protect everyone’s oral health. While removing fluoride might appeal to those valuing personal choice, it risks undoing decades of progress against tooth decay.
Whether through fluoridation or other methods, oral health remains a public health priority. Addressing it requires thoughtful, evidence-based solutions that ensure equity, safety and community well-being.
Amal Noureldin is Clinical Professor of Cariology, Prevention and Restorative Dentistry, Texas A&M University.
The Conversation is an independent and nonprofit source of news, analysis and commentary from academic experts.
© The Conversation
24 Comments
divinda
Being pro-choice about the physical decision of the populace shouldn't be conditional, be it for dentistry, vaccinations, or reproductive issues.
This argument could be said by any anti-choice advocate for any issue.
So in a democratic system, the way to determine what a certain populace wants is to let them vote locally and allow the people to decide for themselves (be it by state, county, or municipality). And if someone within that community does not like what the majority decides, they still have the choice to live elsewhere.
Wick's pencil
No, they are not the same. There is no need to swallow the fluoride. Why should everyone be swallowing fluoride, just to protect the teeth of those who "can't afford" toothpaste or refuse to brush their teeth and insist on consuming sugar.
As is typical for The Conversation, the article seems excessively positive towards the product (fluoride) while being dismissive towards its negative effects, or outright ignoring them. No mention on its possible negative effect on child IQ.
https://pubmed.ncbi.nlm.nih.gov/38318766/
Jay
Water fluoridation is one of the greatest con jobs ever sold to the public... a perfect storm of Big Government overreach, Big Pharma profiteering, and Big Food dependency masquerading as "public health." First, the so-called "scientific consensus" on fluoride's safety conveniently ignores growing studies linking it to neurotoxicity. Research published in Environmental Health Perspectives (2019) found prenatal fluoride exposure significantly lowered IQ in children - a revelation that they'd rather sweep under the rug. Meanwhile, go ahead and Google the review by the National Toxicology Program in 2023 that highlighted links between fluoride and cognitive impairments... but, of course, Big Pharma-backed "experts" unsurprisingly dismissed it as "inconclusive," just as mouthpiece Amal Noureldin is attempting to do here.
Most importantly, let's not forget: it isn’t even a naturally occurring health tonic - it’s an industrial byproduct! Fluoride comes from the aluminum and phosphate fertilizer industries, and was repackaged as a "health solution" to avoid costly disposal regulations. Yet, while we're told it's essential for preventing tooth decay, global statistics show countries that don't fluoridate water often achieve similar or even better dental health outcomes without forcibly medicating their populations.
Reject it. Reject them. Protect your mind and your health.
Zaphod
Jay
Totally agree. It is one thing to add fluoride to toothpastes for those who believe in the benefits, but forcefully medicating an entire population is indefensible. How does the industry know how much medicated water any individual drinks, anyway?
Although somehow I suspect that someone in the comment section will check with world-wide experts and respected institutions of science to explain that forced mass medication is a good thing.
virusrex
Not even remotely the same, one example means to greatly reduce public health expenses by a cheap, safe and effective measure, another is about reducing the risk for everybody from people that make irrational and mistaken choices about their own, the third do not have such contexts.
No it can't, because it depends completely on demonstrating in an objective way the benefits for everybody, nobody is being sacrificed for the common good.
The problem is that what certain population want can be wrong, and knowing the preference does absolutely nothing to correct it, at the end it becomes the fallacy of appeal to popularity, pretending that many people believing something false somehow will make it less so.
But for the argument they are equivalent. Fortification of something to a degree that brings only benefits without any significant risks, even if deeply antiscientific people pretend this is not the case.
Because it is safe, because it is effective and because is the same as every other benefit that applies in general, why pay for services when some will benefit and others not so much?
Because there is no realistic possibility of this being the case, the study unequivocally links much higher levels of fluoridation that are not what is done in water fluoridation, it is a relationship only present on places where the water has these much higher levels naturally. There is zero evidence of any risk at levels used for public health.
Not at all, as easily demonstrated the moment no institution of public health support this claim you make based only on your personal beliefs.
If the experts and doctors around the world coincide in calling fluoridation an excellent medical intervention then it becomes completely irrelevant that nameless people on the internet say those doctors and experts are all wrong, specially without any evidence to prove the claim.
No "pharma-backed experts" as you like to misrepresent but all experts in general, around the world, in every country, the impossible conspiracy you claim is unbelievable for anybody with even a small amount of common sense, only people that themselves would sell their friends and family for money would even believe all doctors would do this.
In reality the benefits of fluoridation are clear
https://www.cbc.ca/news/canada/calgary/fluoride-water-calgary-edmonton-cavity-children-1.6162686
By the levels included water itself would become dangerous long before fluoride, people would die from water poisoning without ever having any problem because of fluoride.
Imagine that, relying on the best experts in the world to decide if something is beneficial or not!
Much worse are people that pretend their personal beliefs are enough to disprove the best experts in the world that have worked decades of their lives for the benefit of public health.
Zaphod
Here we go! What a surprise :-)
Peter14
Dont want vaccination, dont want fluoride in water, dont want modern medical assistance, just want to live as cavemen with shorter life spans. I feel healthy, exercise and eat the "right" foods.
Some people have no clue. Should still be riding horses to get everywhere and make their own clothes. But its true, those people have the right to choose, to choose to be stupid and ignore the experts and the evidence and modern advancement because they dont trust others over greed.
Common sense helps overcome such ignorance. Where can they get some?
Jay
The predictable parroting of “expert consensus” and “public health,” as if those terms are shields against legitimate critique. Let’s start with the tired trope about fluoridation being an “excellent medical intervention.” If dumping industrial waste into drinking water were such a miracle, why is fluoride classified as a neurotoxin by respected journals like The Lancet? Studies repeatedly link even “low levels” of fluoridation to reduced IQ in children (Environmental Health Perspectives, 2019). Yes, the very levels deemed “safe” by your so-called experts.
You claim there’s no risk at public health levels? Wrong again. A 2023 study in JAMA Pediatrics found prenatal fluoride exposure correlated with lower cognitive outcomes in children. Let’s not forget the Harvard meta-analysis (2012), which reviewed 27 studies and found fluoride exposure significantly associated with IQ deficits. Natural levels, public health levels - damage doesn’t stop to check your bureaucratic guidelines.
And your blind faith in “global experts”? Spare me. Governments have historically greenlit poisons - from asbestos to leaded gasoline - long after “experts” endorsed them. Fluoride isn’t a nutrient; it’s a byproduct of fertilizer production. Why are we consuming it, again? Because Big Industry needed a cheap disposal method, and they duped the government into selling it as health policy. Call it what it is: corporatist waste management.
Lastly, your dismissal of dissenters as conspiracy theorists is lazy. Many countries, including Sweden, Germany, and Japan, have rejected water fluoridation entirely, citing ethical concerns and a lack of clear benefit. Are they part of the same “impossible conspiracy,” or just nations that value science over lobbying dollars?
Fluoridation isn’t a gift from science - it’s an insult to common sense. You don’t need a PhD to understand that involuntary mass medication is unethical, and blindly trusting the same institutions tied to Big Food and Big Pharma only ensures we’ll drink to their profits, not our health.
Jay
You're better than that Peter. Let’s talk about your “advancements.” Big Pharma, Big Food, and government health authorities are behind skyrocketing obesity, diabetes, and mental health crises. Yet you mock people who question these systems? Fluoride? Classified as a neurotoxin by The Lancet and linked to lower IQs in children. Vaccines? Mounting evidence of adverse effects gets buried. Big Food? Selling ultra-processed garbage while labeling sugary cereals as “healthy.” That’s your idea of progress is it?
SomeWeeb
Incidentally, most people don't drink unfiltered tap water. Only the poorest of residents usually are doing so, and these are the same people who lack basic dental care and need the fluoride the most.
Zaphod
Jay
Somebody should tell Sweden, Germany and Japan that all the world-wide experts and respected institutions of science disagree with this! Must be all unscientific cavemen.
wallace
Introduced when I was a small child 70 years ago. Can't say I noticed for better or worse.
virusrex
What would be surprising would be for you to finally bring any institution to support your personal opinion, you repeatedly claim this to be the case, only to recognize this is not the case when asked to bring any.
That is the value of expertise and science, to have evidence to refute antiscientific propaganda groups when they claim things easily debunked with evidence. The problem you have with them is because of your personal antiscientific bias. Globally fluoridation is recognized as an extremely valuable medical intervention that greatly benefits public health, but since you are unable to accept anything that contradicts a personal belief your only exit is to pretend there is a global conspiracy including any and all medical institutions of the world that supposedly lie just to contradict what you believe, the same excuse flat earthers or creationist use to defend their also mistaken beliefs. You present no evidence of such conspiracy yet expect people to believe it exist just because you say so, that is not a rational expectation.
So is water, the obvious response that you are willingly choosing to ignore no matter how many times is given to you is that the dose is what makes something beneficial or negative for the health, for the amount of fluoride used in the water there is exactly zero evidence that points to any damage. Contrary to what you claim the levels used for fluoridation do NOT show any negative effect on intelectual development, that is a claim you made and it is false.
You recognize The lanced as a respected journal by bringing it as a reference right? that means you have to recognize it as well when explicitly contradicts your point.
https://www.thelancet.com/journals/laneur/article/PIIS1474-4422(14)70119-X/fulltext
No credible scientific studies show a relation between fluoride consumption and IQ levels; however, several have shown that fluoride ingested at recommended levels is not harmful. Grandjean and Landrigan did not acknowledge the animal study3 that showed no evidence of a neurotoxic effect of fluoride, even at levels up to 230 times the recommended concentration; an earlier study showing that fluoride causes no harm to children;4 two formal reviews that delineate weaknesses in the Chinese fluoride and IQ studies;5,6 and the conclusion by one of these sets of investigators6 that biological plausibility for a link between fluoridated water and IQ has not been established.
You want people to believe you when you claim every single institution of medical science is on a conspiracy to kill and maim people, yet you produce exactly zero evidence of this being the case, once again, only people that would actually do such a thing easily could ever believe the medical community of the world would ever do it, for people with common sense this is obviously impossible.
False, people around the globe are living longer and more productive lives than ever before, why use such an obviously false claim? do you believe people would not find out easily how wrong this claim is?
https://www.who.int/news-room/fact-sheets/detail/ageing-and-health
Countries that fluoridate other things (like salt) can see no extra benefit from fluoridating water as well, none of the examples you are trying to misrepresent have said fluoridation is wrong or unnecessary, they simply do it differently.
Hawk
What do you anti-medicine people do when you break an arm? Go to a vet?
albaleo
Rare suggests it happens sometimes. It seems odd to me that those at risk will have difficulty avoiding it, especially when there are alternative methods for using it. Where I live, water is not fluoridated.
owzer
You: “I like doing this thing, so everybody must do this thing!”
Me: “I don’t want to do that thing.”
You: “I don’t care. I just made the thing unavoidable for everyone.”
Zaphod
virusrex
By who exactly? Are perhaps the health authorities of those countries who refuse this forced medication somehow excluded from your famous obscure "word-wide experts and respected institutions"?
wallace
"Japan does not artificially fluoridate its tap water. The concentration of natural fluoride in tap water varies by region due to geological factors like granite. The regulated level of fluoride in Japan's tap water is less than 0.8 parts per million (ppm)."
Jay
Unfortunately, you seem to fail to understand the irony of preaching "science" while parroting debunked talking points from industries fueled by profit, not public health. You conveniently ignore The Lancet's classification of fluoride as a neurotoxin and peer-reviewed studies linking its overuse to lower IQ in children. Your dismissal of these studies assumes a world where institutions, Big Pharma, and Big Food have no conflicts of interest - severely mistaken. Ever heard of lobbying? Corporate interests? The revolving door between regulators and industry? They're not fairy tales; they’re documented realities.
Your "dose makes the poison" argument is also irrelevant. Fluoride accumulates in the body over time, and its toxicity doesn't vanish because it's in a glass of water instead of a lab vial. Ignoring this fact is willful ignorance. Over 97% of European countries reject fluoridation, citing ethical concerns and health risks. Are they all "antiscience"? Or perhaps they’'e simply not slaves to corporate-backed narratives?
Finally, comparing skeptics of fluoride to flat-earthers is lazy and disingenuous. People against fluoridation of water are actually pro-science; what they're rejecting is corrupted, profit-driven pseudoscience that prioritizes control over health. Try digging into some reliable research. Meanwhile, we'll stick to clean water, untainted by chemicals disguised as "public health."
Zaphod
European countries that refuse tap water fluoridization (incomplete list):
Germany, France, Sweden, Norway, Denmark, Austria, Belgium, Italy, Finland, Switzerland, Portugal, Netherlands, Luxembourg, Iceland, Czech Republic, Poland.
Are the health authorities of these countries all ignorant about this nebulous world-wide expert consensus about the benefits of forced medication with fluor?
Peter14
@Jay. Big Pharma and government health authorities are also responsible for vaccinations that save lives from Diphtheria, tetanus, pertussis, Haemophilus influenzae type b, hepatitis B, polio, TB, whooping cough, Hepatitis B, Pneumococcal, Rotavirus, Meningococcal B, Measles, mumps, rubella and a whole lot more. Now tell me they are all made up big pharma money spinners for gullible governments and people, and that tens of thousands of lives are not saved every year around the globe thanks to these vaccines.
To some "big pharma" is simply evil. There are plenty of documented cases where overpricing medicines, especially in the US is common, but there are many instances where they help save lives. Australia has a long list of subsidized medicines for its citizens.
Governments dont always get things right, they often fail. But sometimes the system works as intended and as people would hope. Celebrate those wins while you heap scorn on the conspiracy theories.
Wick's pencil
And those poorest residents can't afford toothpaste?
Couldn't we just give them a concentrated fluoride solution, which they could use to fluoridated water to swish their teeth?
Why must everyone be forced to bathe in it, drink it, and cook with it?
Jay
Right, so Big Pharma saved the world. Just like Monsanto "saved" farming and McDonald's "saved" dinner time. Come on mate... I mean you could pretend they're altruists handing out miracles; but in reality they’re corporations raking in billions, and public health is just a convenient sales pitch. Ever heard of the opioid crisis? You know, where Big Pharma knowingly created an addiction epidemic for profit? But hey, I’m sure this time they’re saints, right?
You list off vaccines like a grocery receipt - do you honestly think that means there’s no room for debate? No one’s disputing medicine can save lives; rational people are questioning a system that treats citizens like lab rats and lines corporate coffers while ignoring real health solutions like clean diets, exercise, and non-toxic environments. Subsidized medicine? Great. But why are so many of those medicines needed in the first place? Could it be that Big Food and Big Pharma are two heads of the same beast, pumping us full of garbage and then selling us the antidote?
And "the system works as intended"? Sure, if the intention is to funnel power and money to the elite while the rest of us eat their lies for breakfast - probably with a side of processed cereal endorsed by these same "experts."
Of course, you're free to celebrate all you like, but don’t expect us to clap while we choke on the crumbs.
virusrex
Irrelevant, the actual argument is "this thing is proved to improve public health and the easiest cheapest way to do it is including it as a default, which has no demonstrated negative effects"
there is no "liking" involved in fluoridation.
By the scientific and medical communities of the world, you still have been completely unable to find any example where this intervention is deemed negative, you just try to impose your personal (and demonstrably mistaken) opinion about it.
No countries that refuse fluoridation, they are simply doing it differently, your misrepresentation has been already debunked, why repeat it? is it that you have no actual argument so you need to use something already proved false? you have yet to bring any actual authority saying fluoridation is negative for the health as it is done by the different countries.
No debunked points, just because you tried to misrepresent studies as if they said something they clearly not you are not debunking anything, you have not even addressed the reference that clearly proved your point was baseless and the studies that prove the safety of fluoridation are still there without you being able to do anything about them, once again the experts have been very successful in proving the benefits of an intervention and you have no arguments nor evidence against this conclusion.
No it is not, just because you can't understand something that does not make it irrelevant, fluoride do NOT accumulate in the body to any degree of clinical importance at the concentrations used for fluoridation of water, for that it is required many times over the concentration which makes your point clearly false. Once again, the thing that can make fluoride (and everything else) have a negative effect in health is the concentration, baselessly claiming that any concentration of fluoride is poisonous clearly makes no sense.
When your only argument is a global conspiracy that includes every single institution of medicine and science in the world you are the one accepting you are doing the same as flat earthers and creationists, trying to excuse the absolute lack of evidence in the irrational, impossible belief that everybody that knows something about it is included in a conspiracy, in every institution, every country in the world. That is not an argument is an impossible to believe excuse for not having any argument.
No, they are simply fluoridating other things like salt, which makes fluoridation of water unnecessary, they are not against fluoridation, they are doing it differently. Claiming otherwise is just clear evidence that you need to lie in order to defend your point.
And dental education, and opportune attention, on the other hand anybody can simply opt to drink bottled water with any quantity of fluoride, according to you this is enough to justify fluoridation.
I mean, people can even opt to drink the water that RFK Jr sold that had more than double the amount of fluoride that is included in tap water.
Because it has no discernible effect on health, it is as justified as the content of every other mineral that tap water contains.