Federal fluoride supplement crackdown will lead to more Long Island tooth decay, dentists warn

A Trump administration plan to take widely used pediatric fluoride supplements off the market would lead to a dramatic increase in tooth decay in children, especially in places like Long Island where drinking water is not fluoridated, dentists say.

The move, combined with an earlier declaration by Secretary of Health and Human Services Robert F. Kennedy Jr. that the government would stop recommending that communities add fluoride to drinking water, represents a stark change from the federal government’s decades-long promotion of fluoride. Studies over the past 80 years have shown that the mineral dramatically reduces the risk of cavities.

Although fluoride in water and in supplements for children is endorsed by leading medical and dental associations, there long has been opposition to it. That partly was because of conspiracy theories and misinterpretations of scientific data. But over the past several years, some studies of fluoridated water have shown associations between fluoride and behavioral issues and lower IQs in children, although often for fluoride levels much higher than is in most U.S. water.

The May 13 announcement on fluoride supplements by Kennedy and Food and Drug Administration Commissioner Dr. Marty Makary does not affect products such as toothpaste, mouth rinses and topical treatments in dental offices, though dentists say those applications can be less effective at protecting teeth.

The announcement offered few details on how the government would eliminate access to fluoride supplements, other than stating that the FDA plans on “taking appropriate action regarding removal of these products from the market” by Oct. 31. The agency also said it would complete a “safety review” of fluoride and a public comment period by that date.

A Tuesday Health and Human Services email to Newsday said the FDA is “urging manufacturers to voluntarily discontinue the marketing of these products” but “if companies fail to take voluntary action, the FDA will not hesitate to move forward with enforcement measures.”

‘Political decision,’ fluoride expert says

The FDA said there are potential health risks from fluoride supplements, particularly for children.

Yet “there is no major reputable organization that expresses concerns about fluoride,” said Dr. Susan Fisher-Owens, a spokeswoman for the American Academy of Pediatrics. 

“This is making a political decision about a medical treatment,” said Fisher-Owens, a clinical professor in the medical and dental schools at the University of California, San Francisco, and an expert on fluoride.

She said she was concerned whether the “safety review” would be unbiased and medically accurate.

Dentists said they or pediatricians routinely prescribe fluoride supplements to Long Island children, often as part of a multivitamin.

“I have more people asking more questions about how I feel about it,” because of news reports and anti-fluoride postings on social media, said Dr. Douglas Schildhaus, a pediatric dentist in Woodbury. But he said once he explains the science, few parents object.

“What they’re proposing is taking away the right of a parent who says, ‘I want my child to have fluoride. I don’t want them to have cavities,’” said Dr. Eugene Porcelli, executive director of the Nassau County Dental Society.

Porcelli said before he retired from his Garden City practice in 2021, “I prescribed it for virtually all children” from Long Island.

No fluoride in Long Island water

Long Islanders are among about 37% of the U.S. population that does not receive fluoridated drinking water, according to 2022 data from the Centers for Disease Control and Prevention, the most recent available. Fluoridated water reduces cavities by about 25%, the CDC says.

The disappearance of fluoride supplements would mean more cavities and other tooth decay, some of which can cause intense pain and send kids to the hospital, said Dr. Maurice Edwards, a Lynbrook resident who practices in Manhattan and is president of the New York State Dental Association. Dental procedures to address decay can cost thousands of dollars, he said.

The FDA announcement on fluoride supplements included links to scientific studies, mostly on fluoridated water. Yet many of the studies cited were from countries where water has much higher levels of fluoride than in the United States, Fisher-Owens noted. 

Some studies have linked U.S. water to potential health problems. A study led by Ashley Malin, an assistant professor of epidemiology at the University of Florida, found an association between higher levels of fluoride in pregnant women in Los Angeles and a greater probability of neurobehavioral issues in their children such as autism spectrum disorder symptoms and anxiety.

Malin said she supports the FDA’s action and said the focus should be on topic applications of fluoride.

“The current state of the science suggests there may not be a safe level of fluoride to ingest in early development, in terms of impacts on the developing brain,” she said in an interview.

Yet most research has found no such associations, Fisher-Owens said. Other factors, such as socioeconomic status or greater exposure to lead or other substances, could explain neurobehavioral issues, she said. In addition, the way fluoride levels were measured in Malin’s and other studies was flawed, she said.

Gap for low-income children

As Trump administration officials increasingly spoke out against fluoride, Utah became the first state to prohibit fluoridated drinking water, effective May 7, followed by Florida. But Utah paired its ban with a measure to make it easier to obtain prescriptions for fluoride supplements.

“Now we’re concerned about that choice being taken away, here or anywhere in the country,” said Dr. James Bekker, associate dean of the University of Utah School of Dentistry.

Bekker said he could tell by looking at the level of decay in a child’s teeth if they likely came from an area without water fluoridation.

Dr. Steven Feigelson, a dentist in Commack, also noticed a clear difference.

“I started out practicing in Brooklyn, and when I came out to Long Island, I found that the incidence of decay was much higher in children,” he said.

The gap is especially large in low-income children, who are less likely to take fluoride supplements and have regular dental visits, said Dr. Joseph Brofsky, head of pediatric dentistry at Cohen Children’s Hospital in New Hyde Park.

FDA Commissioner Makary said in his May 13 statement: “The best way to prevent cavities in children is by avoiding excessive sugar intake and good dental hygiene.”

“That’s half the battle,” Brofsky said. “The other half is fluoride.”

Additionally, low-income children are less likely to floss and have toothbrushes that are replaced regularly, and many have diets that contribute to cavities because less nutritious food typically is cheaper, said Dr. Greg Maddalena, chief dental officer for Sun River Health, a nonprofit that runs four Suffolk County dental centers that regularly prescribe supplements. They will be among those most hurt by a lack of access to supplements, he said.

Toothpaste and other topical applications of fluoride are not enough for children, Porcelli said. Unlike toothpaste or mouth rinse, fluoride from supplements and water get incorporated into the enamel of a child’s developing teeth, permanently strengthening them, he said.

“For the rest of your life, you have teeth that are way more resistant to decay,” he said.

David Olson covers health care. He has worked at Newsday since 2015 and previously covered immigration, multicultural issues and religion at The Press-Enterprise in Southern California.