NEW YORK — U.S. Health Secretary Robert F. Kennedy Jr. has stated that he wants communities to stop fluoridating their water, and he is putting the government’s wheels in motion to make that happen.
This week, Kennedy announced that he will instruct the Centers for Disease Control and Prevention to discontinue fluoridation recommendations in communities across the country. And he stated that he is forming a task force of health experts to investigate the issue and make new recommendations.
At the same time, the United States Environmental Protection Agency announced that it would review new scientific evidence on the potential health risks of fluoride in drinking water. The EPA determines the maximum level permitted in public water systems.
Here’s how President Donald Trump’s administration has prioritized reversing fluoride policy.
The benefits of fluoride
Fluoride strengthens teeth and prevents cavities by replacing minerals lost through normal wear and tear, according to the CDC. In 1950, federal officials supported water fluoridation to prevent tooth decay, and in 1962, guidelines were established for how much should be added to water.
Fluoride can come from a variety of sources, but the most common for Americans is drinking water, according to researchers. According to CDC data, nearly two-thirds of the United States’ population receives fluoridated drinking water.
The addition of low levels of fluoride to drinking water was long regarded as one of the most significant public health achievements of the twentieth century. The American Dental Association says it has reduced tooth decay in children and adults by more than 25%.
According to a 2022 CDC analysis, approximately one-third of community water systems in the United States — 17,000 out of 51,000 — fluoridated their water, serving more than 60% of the population.
The potential problems of too much fluoride
The current CDC recommendation is 0.7 milligrams of fluoride per liter of water.
Over time, studies have revealed potential issues when people receive far more than that.
Excess fluoride has been linked to tooth streaking or spots. Studies have also found a link between excess fluoride and brain development.
Last year, the National Toxicology Program found that drinking water with more than 1.5 milligrams of fluoride per liter, more than twice the CDC’s recommended level, was linked to lower IQs in children.
Meanwhile, last year, a federal judge ordered the EPA to tighten fluoride regulations in drinking water. U.S. District Judge Edward Chen cautioned that it is not certain whether fluoride causes lower IQ in children, but he concluded that research indicated an unreasonable risk that it could.
Kennedy has railed against fluoride
Kennedy, a former environmental lawyer, has described fluoride as a “dangerous neurotoxin” and “an industrial waste” linked to a variety of health risks. He claims it has been linked to arthritis, bone breaks, and thyroid disease.
Some studies have suggested such links, usually at higher-than-recommended fluoride levels, but some reviewers have questioned the quality of the available evidence and stated that no definitive conclusions can be reached.
How fluoride recommendations can be changed
The CDC’s recommendations are widely followed, but are not mandatory.
State and local governments decide whether and how much fluoride to add to water, as long as the amount does not exceed the EPA’s 4 milligrams per liter limit.
So, while Kennedy cannot order communities to stop fluoridation, he can direct the CDC not to recommend it.
It is customary to convene a panel of experts to sift through the research and evaluate the evidence on the pros and cons of water fluoridation. However, Kennedy has the authority to halt or change a CDC recommendation without it.
“The power lies with the secretary,” but public trust would erode if recommendations were changed without a clear scientific basis, according to Lawrence Gostin, a public health law expert from Georgetown University.
“If you’re really serious about this, you don’t just come in and change it,” said the manager. “You ask somebody like the National Academy of Sciences to do a study — and then you follow their recommendations.”
On Monday, Kennedy announced the formation of a task force to address fluoride, while also ordering the CDC to stop recommending it.
HHS officials did not immediately respond to questions about what the task force would do.
Some places are already pulling back on fluoridation
Utah recently became the first state to prohibit fluoride in drinking water, and lawmakers elsewhere are considering the issue.
An Associated Press analysis of CDC data from 36 states reveals that many communities have discontinued fluoridation in recent years.
According to the AP’s analysis, at least 734 water systems that consistently reported data in those states stopped fluoridating water over the last six years.
Mississippi alone accounted for more than one-fifth of the water systems that failed. According to Melissa Parker, the Mississippi state health department’s assistant senior deputy, the majority of water systems that discontinued fluoridation did so to save money.
During the pandemic, Mississippi’s health department allowed local water systems to temporarily suspend fluoridation due to global supply chain issues. Many never restarted, according to Parker.
CDC funding for fluoride is typically a small factor
Since 2003, the CDC has funded a small number of state oral health programs through cooperative agreements. The agreements are in cycles, and at the start of this year, 15 states were each receiving $380,000 over three years.
The funds can be used for a variety of purposes, including data collection on people with dental problems, dental care, and technical support for community water fluoridation activities.
The current oral health funding is allocated to Iowa, Kansas, Louisiana, Maryland, Michigan, Minnesota, Missouri, Ohio, Nevada, New York, North Dakota, Pennsylvania, South Carolina, Virginia, and Wisconsin.
Federal officials have told the states not to use the money for chemicals because the funding is intended to help set up fluoridation, not for everyday expenses. South Carolina, for example, has set aside up to $50,000 to help communities fluoridate. Iowa spends approximately $65,000 to promote community water fluoridation.
Earlier this year, CDC officials declined to answer questions about how much of the total oral health budget has been allocated to fluoridation.
The CDC’s entire 20-person Division of Oral Health was eliminated last week as part of widespread government staffing cuts, so there is no one to ask.
Congress appropriated funds to the CDC specifically to support oral health programs, and some congressional staffers believe the agency must distribute those funds regardless of who runs the HHS or the CDC. However, Trump-driven budget cuts have targeted several programs that Congress had requested, and it is unclear what will happen to the CDC’s oral health funding.
According to the American Water Works Association, fluoridation is relatively inexpensive when compared to other water department expenses, and most communities simply include the cost in the water rates they charge customers.
In Erie, Pennsylvania, for example, fluoridating water for 220,000 people costs between $35,000 and $45,000 per year and is entirely funded by water rates, according to Craig Palmer, CEO of the Erie Water Authority.
According to some experts, cutting off CDC funding would have little impact on most communities, but it could be more significant for some smaller, rural communities.