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01/24/2025 | News release | Distributed by Public on 01/25/2025 11:22

Making Sense of the Fluoridated Water Debate

Making Sense of the Fluoridated Water Debate

It would be a mistake to eliminate fluoride from public water supplies, especially for poor and vulnerable populations, two experts from the BU Henry M. Goldman School of Dental Medicine warn

President Donald Trump's pick to run the US Department of Health and Human Services, Robert F. Kennedy, Jr., has challenged the long-held practice of adding fluoride to drinking water supplies. Photo via iStock/naumoid

Public Health

Making Sense of the Fluoridated Water Debate

It would be a mistake to eliminate fluoride from public water supplies, especially for poor and vulnerable populations, two experts from the BU Henry M. Goldman School of Dental Medicine warn

January 24, 2025
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Facts first: fluoride is a naturally occurring mineral in water so all water supplies already have some fluoride. The levels of fluoride in public water systems are adjusted up to make the water quality optimal for helping prevent tooth decay.

And just to be crystal clear, the fluoride in water is odorless, tasteless, and colorless.

"So when people say their water tastes funny, it's not the fluoride," says Kathy M. Lituri (SPH'03), a clinical assistant professor and director of Oral Health Promotion at Boston University's Henry M. Goldman School of Dental Medicine.

Community water fluoridation in the United States began 80 years ago, starting in Grand Rapids, Mich. Today, 209 million Americans drink fluoridated water and the vast majority of water systems in America are fluoridated. So why is fluoride, which has drawn little meaningful controversy for almost a century, suddenly a hotly discussed topic in this country?

Because President Donald Trump's pick to run the US Department of Health and Human Services, Robert F. Kennedy, Jr., whose confirmation hearing has been scheduled for January 29, has challenged the long-held practice of adding fluoride to drinking water supplies even though it is, almost unanimously, supported by public health experts and widely credited with reducing tooth decay, a disease that affects almost everyone.

The US Centers for Disease Control and Prevention estimates that 7 out of 10 Americans who get their drinking water from public water systems receive fluoridated water. Studies have found that fluoride builds enamel in children's still-growing teeth and that helps restore enamel in adult teeth. Yet, fluoridation is not as prevalent across all 50 states as some might think-approximately 58 percent of the population in Massachusetts, a notably progressive state, gets fluoridated water, according to 2022 data from the Centers for Disease Control and Prevention, and the commonwealth ranks just 36th among all states for the percentage of residents who have access to fluoridated water.

"The Trump White House will advise all US water systems to remove fluoride from public water," Kennedy said recently.

To gain some perspective and historical context on the issue, BU Today spoke with Lituri and Myron Allukian, Jr., an SDM clinical associate professor of health policy and health services research, who is widely acknowledged as a visionary leader in public health after a nearly 60-year career serving the public, the underserved, and vulnerable populations. Allukian is also a former dental director for the Boston Public Health Commission.

Q&A

with Kathy M. Lituri and Myron Allukian, Jr.

BU Today: Most of us are drinking water with fluoride every day and not even thinking about it, is that right?

Allukian: Yes. In 2022, we had about 72.3 percent of the population on public drinking water supplies in the US with fluoridated water, approximately 209 million people in fluoridated communities. There are another 43 million people without a public water supply. In Massachusetts there are over 4.2 million people living in 130 fluoridated communities, about 62 percent of the population on public water supplies. Boston and its surrounding 31 cities and towns became fluoridated in 1978.

BU Today: So fluoride, from what I'm hearing, is a good thing?

Allukian: Absolutely, for over 80 years. There was a big controlled fluoridation study done in Grand Rapids, Mich., beginning in 1945, and it was based on that study, as well as previous studies in many naturally fluoridated communities, that in 1950 the United States decided fluoride was a good way to prevent tooth decay. So that's when levels of fluoride started to be adjusted.

BU Today: But Robert Kennedy has said fluoride is "an industrial waste associated with arthritis, bone fractures, bone cancer, IQ loss, neurodevelopmental disorders, and thyroid disease." Are any of his concerns rooted in some science?

Allukian: All untrue. There are two types of people against fluoridation. Some people, no matter what the facts are, or what the studies and science show, say they are against it. Other people, once they get the facts, they will support it. I've been dealing with people for and against fluoridation for over 50 years.

And, there are still people who think the earth is flat. No matter what you tell or show them, they believe the earth is flat.

You will always find some outliers. You need a well-informed public. Unfortunately, the Trump administration has ordered all federal health agencies to stop communicating with the public unless it's critical, which would be subject to review. This will create more confusion for the public, potentially resulting in more unnecessary disease and disability.

Lituri: I agree with Myron; certain people won't trust anything, with the internet and all the sources of misinformation and disinformation. It's easy to go down a rabbit hole. It doesn't take much. It's sad and it's too bad that people don't know how to recognize a credible study.

BU Today: OK, so hypothetically then, if fluoride were to be removed from our drinking water supplies, would there be an impact on our health, and on dental health in particular, in 5 or 10 years?

Allukian: The major problem is people will start getting a lot more tooth decay. Kids who don't have access to good health care will end up with a real problem. Everyone will have more cavities, but the ones who will suffer the most are the low-income, children, and minorities. One community that stopped fluoridation had a 66 percent increase in children needing general anesthesia for their dental care. The city then voted to bring fluoridation back, but the damage was already done.

BU Today: But what about people who say you get your fluoride from toothpaste and the dental office?

Allukian: Fluoride toothpaste alone doesn't do it. It's an additive benefit to fluoridation. Fluoride toothpaste only benefits those who use it regularly. Not everyone uses it regularly. Fluoridation benefits everyone in the community and it doesn't cost anything for the individual or family.

Now that's a good deal.

Lituri: Even though you can get fluoride supplements, those can get expensive, and you have to do it every day, so it adds another burden. But having it in the faucet, cooking with it, rinsing vegetables with it, brushing your teeth with it, that's what levels the playing field. It makes it easier for lots of people to get it. It's good for people of all ages. Plus, a lot of people drink bottled water these days and that may not have the optimal amount.

BU Today: Is the dental community taking what Kennedy says seriously and talking about this and what could happen if fluoride is eliminated from drinking water? Or will there simply be too much pushback from the federal government?

Allukian: We're very very concerned because some communities are looking to stop fluoridation because of what Kennedy says. He has a large bullhorn. The uninformed believe him as he has the Kennedy name.

I worked with [US Senator] Ted Kennedy [Hon.'70] on oral health issues. He'd be very, very upset with his nephew. I worked with Senator Kennedy on having oral health included in the national health plan and funding dental public health residencies like we have now at the BU and Harvard Schools of Dental Medicine, as well as other dental schools across the country.

Lituri: There are very few dentists who are anti-fluoridation-the majority believe in it [fluoridation]. There are people concerned about it, mostly dental and public health people who worry that if it does go away, there will be more cavities to fill. To see dentists go against this, it says a lot. What's striking with Robert Kennedy is that he's put this on the national level. Usually fluoride fights are on the local level, but he's put it on the national level and that's a shock to the system.

Allukian: Community water fluoridation is the most cost-effective preventive measure we have for tooth decay. It is nature's way to prevent tooth decay.

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