Guest column: Fluoride’s benefits have been proven over time. Why are we moving away from it?

Fluoride has been used in drinking water for decades to help prevent cavities, but this common practice is now under attack. The movement has gained momentum in Florida and has the support of the nation’s health secretary, Robert F. Kennedy Jr.

Any efforts to end fluoridation of public water supplies must be viewed with a critical eye. As a family nurse practitioner with a master’s degree in public health, I cannot overstate the urgency of safeguarding this vital public health measure.

The evidence in support of fluoridation is overwhelming and irrefutable. Since Grand Rapids, Mich., became the first city to fluoridate its water in 1945, communities with fluoridated water have consistently reported significantly lower rates of tooth decay. This breakthrough is grounded in the pioneering research of Dr. Frederick McKay who, in the early 20th century, discovered the benefits of naturally occurring fluoride in Colorado water: While it caused minor tooth discoloration, it drastically reduced decay.

Today, federal guidelines recommend maintaining fluoride levels at 0.7 mg/L — an optimal concentration that maximizes cavity prevention while ensuring safety. The results are compelling: Fluoridation reduces tooth decay by 25% in both children and adults, and children in fluoridated areas experience, on average, 2.25 fewer cavities than their peers in non-fluoridated regions.

By preventing cavities, fluoridation reduces the need for expensive procedures such as fillings, root canals and extractions — many of which are not fully covered by insurance. The benefits extend beyond health care costs as untreated dental issues can lead to missed school days for children and decreased productivity for adults, affecting both educational outcomes and economic well-being. Fluoridation helps mitigate these challenges, ensuring healthier communities while alleviating financial burdens.

Organizations such as the Centers for Disease Control and Prevention and the American Academy of Pediatrics unequivocally endorse water fluoridation as the most effective and economical way to prevent tooth decay. Beyond oral health, fluoridation promotes health equity by acting as a powerful equalizer that provides cavity prevention to all families regardless of income or access to care. At a time when health care disparities are widening, this intervention is more crucial than ever.

Critics of fluoridation cite isolated studies suggesting potential neurodevelopmental effects in children exposed to high fluoride levels. However, these studies often focus on regions with fluoride concentrations far exceeding the strict regulatory limits maintained in the United States. Here, careful monitoring ensures fluoride remains within safe and effective ranges, mitigating any risks.

Despite decades of robust scientific backing, fluoridation programs face mounting threats. Social media has become a hotbed for pseudoscience and conspiracy theories, eroding public trust in proven public health practices.

As we face these challenges, we must not allow baseless fears to dictate public health policy. The evidence is clear, the benefits are undeniable and the need for fluoridation is urgent. The obligation to protect the oral health of our communities, especially our children, remains constant. The time to act is now to protect our communities and uphold a legacy of public health progress.