No longer adding fluoride to public water systems may worsen dental health in children and increase dental costs by billions within five years, according to a new study published on May 30 in JAMA Health Forum.
This study highlights that there are benefits to community water fluoridation, which states like Utah and Florida have stopped, at safe levels despite concerns of potential neurotoxicity, the authors wrote.
“This cost-effectiveness analysis found that cessation of public water fluoridation would increase tooth decay and health system costs in the US,” wrote the authors, Sung Eun Choi, PhD, of the Harvard School of Dental Medicine in Boston and Dr. Lisa Simon of Brigham and Women’s Hospital in Boston.
Recently, community water fluoridation in the U.S. has been under increased scrutiny.
In May, the U.S. Food and Drug Administration announced that it is taking steps to remove concentrated ingestible fluoride prescription drops and tablets for infants and toddlers from the market following a safety review and public comment.
The U.S. Department of Health and Human Services Secretary Robert F. Kennedy has promised to recommend ending water fluoridation since before President Donald Trump was reelected. Kennedy has claimed that the cavity-fighter fluoride is an "industrial waste associated with arthritis, bone fractures, bone cancer, IQ loss, neurodevelopmental disorders, and thyroid disease."
In April, the U.S. Environmental Protection Agency announced that it would swiftly review new scientific data on the potential health risks associated with adding fluoride to public drinking water. The announcement was made during an event with Kennedy in which he also said he plans to direct the U.S. Centers for Disease Control and Prevention to stop recommending fluoride's addition to public water systems while putting together a task force to discuss and act on the issue.
In September 2024, a U.S. judge in California issued a milestone decision that adding fluoride to public drinking water to help prevent tooth decay is risky to individuals, including children, who may face lowered IQs. Therefore, the practice requires government intervention.
To determine the cost-effectiveness of no longer adding fluoride to public drinking water and how it may affect the oral health among children in the U.S., an analysis was conducted to estimate changes in total tooth decay and healthcare costs during five- and 10-year periods.
A microsimulation model of oral health outcomes was constructed based on oral health and water fluoridation data of 8,484 children from ages 0 to 19 in a sample from the U.S. National Health and Nutrition Examination Survey (NHANES) 2013 to 2016. Data analysis was completed from November to February 2024.
Eliminating fluoride raised the total number of decayed teeth by 7.5 percentage points, or 25.4 million more teeth, over five years. It was equivalent to a tooth for 1 out of every 3 children, the authors wrote.
Additionally, removal of fluoride was estimated to cost $9.8 billion more in dental care costs over five years. After 10 years, that figure climbed to $19.4 billion, they wrote.
Nevertheless, the study had limitations. Data from NHANES are subject to recall biases, acceptability biases, and underreporting, which may lead to dental care use being underestimated, the authors wrote.
“Despite concerns regarding toxic effects associated with high levels of fluoride, this model demonstrates the substantial ongoing benefits of water fluoridation at safe levels currently recommended by the US Environmental Protection Agency, the National Toxicity Program, and the Centers for Disease Control and Prevention,” Choi and Simon wrote.
