Grand Rapids was first to put fluoride in its water 80 years ago. Will RFK Jr. change that?

This article has been updated to include figures from a Juneau, AK study on the removal of fluoride from public water.

GRAND RAPIDS, MI – Grand Rapids has a unique claim to fame – it was the first city in the world to add fluoride to its public water supply to prevent tooth decay.

In Michigan’s second largest city, community water fluoridation has been in practice in some form for 80 years.

But that could change, with a decades-old debate about use of the chemical reignited before the 2024 presidential election.

Robert F. Kennedy Jr., an environmental lawyer who is President Donald Trump’s pick to run the Department of Health and Human Services, has long raised health concerns about fluoride. He’s said the Trump administration would push for fluoride’s removal from drinking water.

The second day of his Senate confirmation hearing is underway Thursday, Jan. 30. The first day was contentious, revisiting conspiracy theories he’s spread and controversial views on health care, including vaccines and fluoride.

RELATED: What might an RFK Jr.-run U.S. health department mean for Michigan?

Kennedy has repeatedly linked the use of fluoride to health concerns like arthritis, bone fractures, bone cancer, IQ loss, neurodevelopmental disorders and thyroid disease, some of which have been studied in connection with excessive fluoride consumption.

Many public health officials are widely accepting of the use of fluoride so far, and the practice has been lauded by the Centers for Disease Control and Prevention (CDC) as one of the 10 greatest health achievements of the 20th century.

Dr. Christopher Smiley, a now-retired dentist and member of both the West Michigan District Dental Society and the Michigan Dental Association, said he believes the continued use of fluoride in Grand Rapids water has had a profound impact on decreasing the rate of tooth decay.

“It wasn’t uncommon back in that day for people to give dentures as a wedding present,” he said. “Decay was just that rampant in our society.’

But fluoridation has also long been a topic of debate, and has been banned in several west European countries, including France, Germany and Sweden.

Renewed attention with Kennedy’s nomination has sparked discussions about its history, impact and effectiveness in Grand Rapids and around the world.

Since adding the chemical in 1945, the city has only reconsidered the use of fluoride once – in 2008. That’s when Grand Rapids’ then-director of sustainability spoke about gathering a team of Grand Valley State University (GVSU) scientists to study the effects of fluoride.

RELATED: Fluoride pioneer Grand Rapids rethinks safety of putting chemical in water

Former Mayor George Heartwell, who opposed the idea when it was presented, said today the former city sustainability director “took it on himself to question the need for fluoridation.”

That director eventually withdrew his concern, Heartwell said, and the study did not get off the ground.

Grand Rapids water system also supplies drinking water to several partner communities, including East Grand Rapids, Kentwood, Walker and portions of Ottawa County and the townships of Ada, Cascade, Grand Rapids and Tallmadge.

The city first added the chemical as part of a national study to determine its effectiveness at preventing cavities.

Grand Rapids was chosen as the test site because of its large population of school-aged children, its proximity to Lake Michigan (which is mostly free of natural fluoride) and its distance from Muskegon, which served as the control city.

The study was deemed successful and led to nationwide implementation. It became a U.S. Public Health Service policy in 1951 and was widely used in Michigan and across the country by 1960.

The practice of community water fluoridation today means adjusting the amount of naturally occurring fluoride in drinking water to a recommended level – around 0.7 milligrams of fluoride per liter of water.

In a social media post in November 2024, Kennedy said he’s hoping to end the practice all together. He said one of Trump’s first day actions in the White House would be to advise all U.S. water systems to remove fluoride from public water.

Trump has yet to make an executive order referencing fluoride, but has expressed support for Kennedy’s position.

The maximum allowable concentration of fluoride is defined by the U.S. Environmental Protection Agency (EPA) as 4.0 milligrams per liter. Exposure at high levels for a long period of time can lead to a bone disease called skeletal fluorosis, or the weakening of bones.

The National Toxicology Program has also concluded that high levels of fluoride exposure in children, such as water with more than 1.5 milligrams of fluoride per liter, are associated with lower IQ.

However, the study had insufficient data to determine if the fluoride level of 0.7 milligrams per liter recommended in the U.S. had a similar affect. The study found no evidence that fluoride exposure had adverse effects on adult cognition.

The EPA has set a safety standard for fluoride at 2 milligrams per liter of water, which is intended to also help children avoid tooth discoloration.

The Grand Rapids water system “follows strict EPA guidelines and regulations, as do all public water systems,” said Steve Guitar, the city’s media relations manager.

The system serves 273,005 residents, according to numbers shared by the CDC.

Michigan dentists groups, like the Michigan Dental Association, continue to support fluoridation as a “safe, effective and equitable way to prevent tooth decay for everyone, regardless of age or income.”

In 2020, Grand Rapids was recognized by Michigan Gov. Gretchen Whitmer for its leadership on the matter.

RELATED: Grand Rapids celebrates being first city in U.S. to add fluoride to water

Smiley said after an initial 65% reduction in the rate of tooth decay, community water fluoridation still accounts for a 20% reduction in the decay rate, despite the use of toothpaste and other available sources of fluoride.

He said Grand Rapids and the surrounding areas have reaped the benefits of fluoridation for years without seeing an increase in the potential side effects that “alarmists have reported concern about.”

“We don’t experience that in Grand Rapids,” Smiley said.

Sarah Clark, a research scientist in the department of pediatrics at Michigan Medicine, said it’s “important and good to reevaluate public health recommendations periodically to make sure they’re still achieving their goals and are not having negative effects.”

In an article, Clark said public health officials prior to 2015 recommended fluoride levels at between 0.7 and 1.2 milligrams per liter.

That has since been brought down to 0.7 mg/L, due to additional research and testing being done.

But at the same time, Clark said it’s also important to consider all the factors that went into completing studies when analyzing their credibility.

In some cases, like a 2025 compilation of global research linking fluoride exposure to children’s IQ scores, Clark said differences in methods used and water quality analyzed could impact credibility, especially in cases where water also has higher levels of things like lead.

She said it also matters if testing is done at currently recommended levels of fluoride or higher concentrations.

All these differences, if not considered, can be like “comparing apples to oranges,” she said.

Clark said she feels more data is needed reflecting the current fluoride target level of 0.7 ppm. Diverse groups of stakeholders are then necessary to review the data and think about any potential changes in fluoridation recommendations.

Smiley said other studies done since the 1950s have supported the claim that fluoride in water remains necessary.

That includes a 2018 study in Juneau, Alaska that found decay-related treatment costs increased over nine years following the removal of community water fluoridation by 47%.

A similar phenomenon in Grand Rapids would disproportionately impact low income residents, Smiley said.

“Removing community water fluoridation really is not something that should be on the table,” he said.

As a long-time West Michigan resident, Smiley said he believes community members across the region, especially those who have spent generations raising their children, see the long-term benefits of community water fluoridation.

He said it may be a different situation if Grand Rapids was a community looking at adding fluoride for the first time, “but we’ve lived with it for 80 years and had a great experience.”

“Community water fluoridation is simply adjusting the level of fluoride to the optimal level,” he added. “Dose matters… Too little, and it doesn’t work. Too much, and you can add adverse side effects, and just right gives us all these wonderful protections.”

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