RFK Jr. attacking fluoride in our water has finally killed my belief in righteousness | Opinion – Fort Worth Star-Telegram

Public water systems add fluoride to drinking water to help strengthen teeth. This is considered one of the great public health achievements, credited as a major factor in the decline in tooth decay in the second half of the 20th century, by the Centers for Disease Control and Prevention.

But Health and Human Services Secretary Robert F. Kennedy Jr. is asking the CDC to change its recommendation on adding fluoride to drinking water.

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Kennedy has called the mineral “industrial waste” and alleges that consuming it can lead to bone fractures and neurodevelopmental disorders. These risks outweigh the benefits, he claims.

Both the American Academy of Pediatrics and the American Dental Association support continued fluoridation of water. As of Dec. 31, 2022, more than 62 percent of Americans were receiving water with added fluoride.

Scott Tomar, a professor and associate dean at the University of Illinois at Chicago’s College of Dentistry and a spokesperson for the American Dental Association, said water fluoridation is a safe, cost-effective way to prevent tooth decay.

“It is actually one of incredibly few public health measures that not only prevents disease but actually saves money,” Tomar said.

The Washington Post asked Tomar and other oral health experts about fluoride’s effect on dental health. Here’s what they said.

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Fluoride protects our teeth and gums

A hard covering called enamel – made mostly of calcium and phosphorus – protects our teeth from damage. Enamel can be eroded by such things as acid from bacteria that break down sugar in the foods and drinks we consume; wear and tear; teeth grinding; certain medications; and some illnesses.

Fluoride is a mineral. In young children, it can help make teeth stronger and more resistant to decay, Tomar said. Once teeth are fully formed, fluoride can bind with the calcium and phosphate on the surface of teeth to form a stronger enamel, he said. Fluoride strengthens teeth by replacing the minerals lost from wear and tear on the enamel, and can protect against dental plaque, which leads to gum disease.

Early in life, fluoride can provide some benefits in tooth development, said Steven Levy, an endowed professor of research at the University of Iowa College of Dentistry and Dental Clinics. But “a lot of the benefit” from the mineral comes from “bathing the outside of the tooth and strengthening it to resist cavities,” said Levy, who also serves on the ADA’s National Fluoride Advisory Committee.

Excessive amounts of fluoride, though, may increase the risk of problems. For example, in young children, too much of the mineral over a long period of time during tooth development may lead to fluorosis. White spots may form on the enamel, a cosmetic condition that is usually mild in the United States, according to the CDC.

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Fluoride amount in drinking water is safe

The CDC recommends that community water supplies have fluoride at a concentration of 0.7 milligrams per liter, which “maximizes fluoride’s oral health benefits while minimizing potential harms, such as dental fluorosis.”

An earlier level, set in 1962, was a range of 0.7 to 1.2 milligrams per liter. The federal government updated its guidelines in 2015 to recommend 0.7 milligrams of fluoride per liter. States and local governments decide whether to add fluoride to municipal water systems.

Gary Slade, the John W. Stamm distinguished professor of dentistry at the University of North Carolina Adams School of Dentistry, said the fluoridation of drinking water has been studied for more than a century, and “we know the right amount to use to make it safe and make it effective.”

“Fluoride is a naturally occurring substance; it’s the 13th-most-common element in the Earth’s crust,” Slade said. “We have a century of research to know the right amount.”

He said that “we need to always be vigilant” about fluoride and the concerns about the mineral’s effects on young, developing children.

“But the studies to date do not give any reason for concern about 0.7 milligrams per liter, which is the concentration we use in drinking water in the United States,” Slade said.

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Fluoridated toothpaste is not a substitute

The federal government’s updated recommendation for 0.7 milligrams of fluoride per liter reflected the prevalence of other sources of fluoride, including toothpaste and mouthwash, the Department of Health and Human Services said in 2015.

A review of the research by Cochrane Library, considered a gold standard in reviewing evidence-based medical research, determined that water fluoridation may have a smaller benefit for teeth nowadays, given the use of fluoridated toothpaste and other products. Still, one author of the review has said the conclusion shouldn’t be used to justify removing fluoride from public water systems.

Fluoridated toothpaste is not a substitute for fluoridated water, Slade said. Water with fluoride provides an additive, not a redundant, protection for teeth, he said.

Slade was a co-author of a 2018 study of more than 10,000 children in the United States that found fluoridated water had a preventive benefit against tooth decay.

Nowadays, toothpaste and mouthwash contain added fluoride at concentrations 1,000 times higher than the levels in drinking water, Tomar said. Community water fluoridation provides “a very, very low level of fluoride throughout the day,” he said.

People can also get topical fluoride treatments when they go to the dentist. “However, usually, you’re only getting the fluoride in the [dental] office once or twice a year,” Levy said. That’s why public health officials have recommended people do all three: drink fluoridated water, brush their teeth twice a day and go to the dentist regularly, he said.

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Fluoridated water benefits people of all ages

Tooth decay is a chronic disease, Slade said. Cavities develop again and again, into adulthood, and they can lead to a lifetime of toothaches.

But water fluoridation is one of the “cost-saving” treatments in dentistry, Levy said. It costs about a dollar per person per year, for most water systems, and it’s been estimated to save $20 per person per year in costs of cavities and tooth decay, he said.

“And another thing is that you don’t have to have the time and the energy and the resources of going to the dentist to be able to benefit,” Levy said. “It’s the most cost-effective and the only cost-savings way to really prevent cavities on a large-group basis.”

Fluoridation of drinking water has the “greatest effect” in low-income communities, where families have less access to healthy food options, dental care or other forms of fluoride, Tomar said.

“We still run into many kids that tell us they don’t have toothpaste in the house,” he said. “Those will be the families most heavily hit when we stop fluoridation.”

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The risks of high levels of fluoride

Some communities have voted against fluoridation, and last month, Utah became the first state to prohibit adding the mineral to public water systems over concerns about harms to children’s health.

Last year, a report from the federal government’s National Toxicology Program concluded that relatively high levels of fluoride – more than 1.5 milligrams per liter, which is more than twice the amount found in the U.S. – are associated with slightly lower IQ in children.

Kyla Taylor, a health scientist in the National Institute of Environmental Health Sciences’ Division of Translational Toxicology and a co-author of the report, said in an email that there’s concern pregnant women and children are getting fluoride from many sources nowadays, “including drinking water, water-added foods and beverages, teas, toothpaste, floss, and mouthwash.”

“Pregnant women and parents of small children should be mindful of TOTAL fluoride intake,” Taylor said. “If their water is fluoridated at high levels, people may wish to replace tap water with low-fluoride bottled water, like purified water, and limit exposure from other sources such as dental products or black tea.”

Tomar said “almost all” of the evidence in the review comes from countries such as China, India and Iran that have “very high levels of fluoride in their drinking water.”

“It really has no relevance to the levels of exposure that we have in the United States,” he said. “The preponderance of evidence suggests no association between fluoride exposure and any measure of brain development in kids at the levels that we use in fluoridation.”

“At very high levels” of exposure, fluoride can lead to higher rates of bone fractures, Levy said. But he conducted a study of fluoride intake that measured bone density in early age and found no meaningful relationship between fluoride intake in the United States and bone health.

“The best evidence shows that there are not concerns with bone health or with neurodevelopment that warrant us not continuing to fluoridate,” he said.

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Fenit Nirappil and Dan Diamond contributed to this report.

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Video: Robert F. Kennedy Jr. has said he wants fluoride out of America’s drinking water. Health reporter Fenit Nirappil explains how tension over the issue has already divided some Oregon cities.(c) 2025 , The Washington Post

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