Explainer: What is fluoride and why is it added to the US water supply?

Nutrien

13/02/2025 21:00

(Updates with Kennedy's Senate confirmation in first paragraph)
       Feb 13 (Reuters) - Robert F. Kennedy Jr., who heads the
Department of Health and Human Services, has said U.S. President
Donald Trump will call for an end to adding fluoride to public
water supplies. Trump has not announced a position but said it
is possible he would make such a recommendation.
    Recent developments surrounding the issue include new
studies reporting on the potential risks and benefits of
fluoride exposure. Here is what you need to know about
fluoridation of drinking water as a public health measure.
         
    WHAT IS FLUORIDE AND WHAT ARE ITS BENEFITS?
    Fluoride is a mineral that occurs naturally in water, soil
and air that has been demonstrated to prevent dental cavities,
or tooth decay. It works by strengthening the tooth's enamel,
its hard outer surface, making it more resistant to the acid
produced by bacteria that cause tooth decay. Fluoride also
reverses early tooth decay by replacing and preventing loss of
minerals in teeth.
    Prior to the beginning of community water fluoridation,
tooth decay was widespread and severe among Americans. After
fluoride was added in many places to the U.S. water supply,
tooth decay declined in both children and adults, and complete
tooth loss in older adults became more rare, according to
federal health officials.
     
    WHAT DO RECENT STUDIES SHOW ABOUT FLUORIDE BENEFITS? 
In January, researchers at the U.S. National Institutes of
Health who analyzed 74 studies from 10 countries found IQs were
lower in children with higher fluoride exposure. In four studies
with a low risk of bias involving  4,179 children, urinary
fluoride concentrations at levels reportedly common in developed
countries were associated with lower IQ scores, the researchers
reported. 
The results "support concerns for vulnerable populations living
in communities with fluoridated water," according to an
editorial published with the report. A second editorial,
however, details multiple weaknesses of the NIH analyses and
warns that public policy concerning fluoride "should not be
affected by the study findings."
A review published in October 2024 by the Cochrane Database of
Systematic Reviews raised questions about the value of
fluoridation of public drinking water in wealthy countries based
on the findings of 157 studies.
The research suggests that given the widespread addition of
fluoride to toothpaste since 1975, community water fluoridation
may now have only modest benefits in reducing tooth decay and
increasing cavity-free children, compared to the effects seen in
earlier studies. New lawsuits, however, are challenging
manufacturers on the safety of fluoride levels in toothpaste,
too. 
    The review also found there is not enough evidence to
determine the impact of stopping fluoridation or its effect on
socioeconomic disparities in dental health.
     
    WHEN DID WATER FLUORIDATION AS A POLICY BEGIN?
    In the early 20th century, some U.S. researchers observed
that people who lived in areas where community water supplies
had naturally occurring high levels of fluoride had teeth that
were resistant to decay. 
In 1945, the Michigan city of Grand Rapids became the first to
add fluoride to its water supply in a controlled manner, kicking
off what was in effect a large-scale public health experiment.
Data over a 15-year span showed a reduction of more than 60% in
tooth decay among 30,000 school children in Grand Rapids,
demonstrating fluoride's protective benefits.
    By the 1950s, the U.S. government's Public Health Service
and the American Dental Association acknowledged the success of
water fluoridation in reducing cavities. This led to the broad
U.S. adoption of adding fluoride in community water supplies and
eventually its inclusion in dental products such as toothpaste
and mouthwash. 
    No federal law mandates fluoridation of water supplies. The
decision to fluoridate water is typically made by municipal
governments, city councils or local water authorities. 
     
    HOW WIDESPREAD IS FLUORIDATION IN THE U.S.?
About 63% of all Americans have fluoride in their community
water systems, according to CDC statistics as of 2022. 
According to the American Dental Association, the average cost
per year for U.S. communities to fluoridate their water supplies
ranges from 50 cents per person for large communities to $3 per
person for small communities. 
    In most of the world, fluoride is not added to the public
water supply. Some countries add fluoride to table salt. In some
regions, fluoride levels in water are naturally high. 
     
    ARE FLUORIDE LEVELS REGULATED?
    The U.S. Public Health Service recommends that drinking
water levels for fluoride remain below 0.7 milligrams per liter.
Levels above 1.5 mg/L are known to increase health risks such as
bone fractures, thyroid disease and nervous system damage. 
The enforceable limit as set by the U.S. Environmental
Protection Agency is 4.0 mg/L. A federal judge in California
recently ordered the EPA to strengthen its regulations.
     
    WHAT COMPANIES MAKE FLUORIDE?
    Fluorosilicic acid is the compound most widely used in water
systems as it yields free fluoride rapidly when mixed with
water. J.R. Simplot and Nutrien's  NTR.TO  PCS Phosphate Company
are among companies that manufacture the product, according to
the EPA.   
    Total U.S. domestic production of fluorosilicic acid from
phosphate rock was approximately 29 million kilograms (32,000
tons) in 2019, according to EPA statistics.   
     
    WHAT DID KENNEDY SAY?
    Kennedy, the former independent presidential candidate who
subsequently endorsed Trump, is Trump's pick to be U.S. health
secretary. In a social media post three days before Trump was
elected, Kennedy wrote that on Jan. 20, "the Trump White House
will advise all U.S. water systems to remove fluoride from
public water," noting the day of Trump's inauguration. 
    Kennedy has claimed in the absence of conclusive evidence
that water fluoridation at U.S. levels is associated with
numerous health issues including cancer.
     
    WHAT DO PUBLIC HEALTH EXPERTS SAY?
The U.S. Centers for Disease Control and Prevention has called
fluoridation of drinking water one of the nation's top 10 public
health achievements of the 20th century, noting that it
effectively prevents tooth decay regardless of a person's
socioeconomic status or access to care.
The American Dental Association has reiterated its support for
community water fluoridation to help prevent tooth decay.
Studies show that community water fluoridation reduces tooth
decay by more than 25% in children and adults even in an era
with widespread availability of fluoride from other sources such
as toothpaste, the association said.
    Adding fluoride to the water supply has been a boon to the
dental health of Americans, and research shows there is a very
low risk of adverse consequences, according to Kellogg Schwab of
Johns Hopkins Bloomberg School of Public Health in Maryland.
    Not all officials agree. Florida Surgeon General Joseph
Ladapo, who had a history of controversial public health stances
during the COVID-19 pandemic, recently recommended against
adding fluoride to community water supplies, citing inconclusive
studies that suggest the practice poses a risk to children’s
brains.
         

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(Compiled by Reuters staff; Editing by Nancy Lapid, Bill Berkrot
and Lisa Shumaker)