Dentists: Removing fluoride from water good for business, bad for health

Kennedy said last week he was directing the Atlanta-based Centers for Disease Control and Prevention to stop recommending fluoridation in drinking water, alarming dentists and public health experts.

“Stopping community water fluoridation is a step backwards for public health,” said Kristen Morgan, CEO of the Georgia Dental Association.

It is not clear what impact any change to the CDC’s recommendations would have in Georgia.

A 1969 state law enables the Georgia Department of Natural Resources to require fluoridation, which the department has done. But the state does not require a minimum fluoride concentration, according to the Environmental Protection Division, which regulates drinking water. The Georgia Department of Public Health provides a recommended range, but does not have authority to enforce it, a spokesperson said.

“Dental decay is a disease of such magnitude that practically the entire population of Georgia suffers from it,” the regulation states. “No age group is immune and no social strata are exempt. Every major health organization in the state and nation advocates fluoridation of public water supplies as the most acceptable public health approach in reducing the tremendous backlog of this disease.”

Communities can opt out of the law with a referendum, but few have. As of 2022, more than 95% of Georgians were drinking fluoridated water, according to the CDC.

An attempt to repeal Georgia’s fluoride law last year never received a committee hearing in the state Senate. Leaders of natural resources committees in both houses of the Legislature and Gov. Brian Kemp did not respond to questions about the potential impacts of changing CDC recommendations on the state law.

The city of Atlanta and the largest suburban water utilities did not indicate whether they would support fluoride referendums if the CDC’s recommendations change.

“The CDC continues to recommend community water fluoridation at the concentration recommended by the United States Public Health Service guidelines,” Cobb County-Marietta Water Authority General Manager Cole Blackwell said. “This remains a cornerstone strategy for preventing tooth decay in the United States.”

Children who grow up without fluoride are more likely to develop long-term oral health problems, doctors and dentists say.

Morgan echoed the American Dental Association, which says fluoride from food, drinks and supplements strengthens tooth enamel against decay even before teeth break through gums. After teeth erupt, fluoride helps heal weakened enamel and early tooth decay.

Many dentists set a goal of getting children and young adults past age 23 with minimal decay, Goldstein said.

“It’s mainly for the kids that fluoride is so important,” he said. “Kids eat sweets and they don’t usually floss.”

Although fluoride is widely available from other sources such as toothpaste, fluoridating water still reduces dental decay by at least 25%, according to the ADA, which calls community water fluoridation “the single most effective public health measure to prevent tooth decay.” It is especially beneficial in underserved communities with limited access to dental care.

The alternative, Morgan said, would be more cavities, which can become painful and lead to sleep loss and trouble eating, speaking and focusing attention.

In the United States, fluoridating water costs large communities an average of 50 cents per person per year and small communities up to $3 per person annually, the ADA says.

The World Health Organization also supports community water fluoridation.

But there can be a downside.

Excessive fluoride exposure can lead to dental fluorosis — a cosmetic condition in which teeth become pockmarked with spots or streaks. It’s typically caused by overexposure during early childhood, according to the WHO. In rare cases of very high exposure, usually from industrial sources or well water, skeletal fluorosis can occur, affecting bones and joints.

Some critics also cite concerns about potential links to neurological effects, though most major health agencies, including the CDC and the WHO, maintain that fluoridation at recommended levels is safe.

Fluoridation began in the 1940s

The practice of adding fluoride to public water systems in the U.S. began in the 1940s. The idea emerged after studies in the early 20th century found that communities with naturally high levels of fluoride in their water had significantly lower rates of cavities, according to the CDC.

One pivotal study was led by the National Institutes of Health and began in 1945 in Grand Rapids, Michigan — the first city to add fluoride to its municipal water. Over time, researchers documented a dramatic decline in dental disease among children, according to the NIH.

The success of that study prompted other cities to adopt fluoridation. By the 1950s and 1960s, it had become a widely accepted public health practice, endorsed by the U.S. Public Health Service and the American Dental Association. The CDC later named water fluoridation as one of the 10 great public health achievements of the 20th century, citing its safety, cost-effectiveness and impact on reducing dental health disparities.

Kennedy has become a prominent opponent of water fluoridation, citing concerns about potential health risks. He refers to fluoride as “industrial waste” and associates it with various health issues, including neurological damage and bone cancer, according to Vox.

Kennedy’s stance is influenced by studies suggesting that high levels of fluoride exposure might be linked to lower IQ in children, although these studies often involve fluoride concentrations exceeding current U.S. recommendations, The Associated Press reported.

Credit: AP

Credit: AP

There is a long-standing consensus among major health organizations that water fluoridation is a safe and effective public health measure. Still, Kennedy continues to advocate that it not be added to American water systems, reflecting his broader skepticism of certain public health policies.

The European Commission, the European Union’s executive body, says concentrations of fluoride in groundwater in the EU is generally low, but some countries’ waterways have higher amounts — similar to what Americans discovered in Michigan 80 years ago. Ireland, Spain and the United Kingdom currently add fluoride to drinking water, at levels ranging from 0.2 to 1.2 parts per million.

Austria, France, Germany, Switzerland and several other countries known for salty and savory cuisine add fluoride to table salt. In addition to using toothpaste with fluoride, many people use weekly “fluoride gels.”

But experts say free health care and dental care for all people in most EU countries also accounts for better dental and overall health in Europe.

While there is substantial research supporting fluoride’s effectiveness in reducing tooth decay, more research is needed into the long-term effects of fluoride exposure on immune health, said Babak Baban, a professor, immunologist and associate dean for research at the Dental College of Georgia at Augusta University.

“The potential removal of fluoride from Georgia’s water supply is a significant and complex issue, especially given the state’s diverse population and the importance of fluoride for dental health in underserved communities,” he said. “Yes, this is a topic that is being actively discussed in Georgia, and it reflects a broader debate about public health, personal choice and the ethical implications of water fluoridation.

“The decision to remove fluoride should be made carefully, taking into account both the long-term benefits to dental health and the potential risks, while also ensuring that public health policies are informed by sound scientific evidence.”

A preventive measure

DeKalb County was the first in Georgia to fluoridate its public water supply, according to the DeKalb History Center. According to the organization, the county began adding fluoride in 1950.

Within a year, dental disease rates dropped significantly in DeKalb, according to Dr. Thomas Vinson, the county health officer at the time.

State law requires a petition of 10% of those registered to vote in the last general election to call a fluoride referendum in a community.

Since 2008, a dozen rural communities in Georgia have voted against fluoridating public water, according to the Fluoride Action Network, an anti-fluoride group. Crawford County in Middle Georgia rejected fluoride in 2020, according to news reports.

For the past decade, the U.S. Public Health Service has recommended that water systems maintain a fluoride concentration of 0.7 parts per million.

The Georgia Environmental Protection Division requires public water systems to monitor fluoride levels and submit results to the state. Water systems must notify the public if the fluoride concentration exceeds 2 parts per million, according to state regulations. Georgia DPH recommends a range between 0.7 and 1 parts per million, ideally 0.85.

Some of the largest water utilities in metro Atlanta buy fluoride from Univar Solutions, a global chemical distributor based in Illinois. The chemicals delivered to metro Atlanta are usually produced in North Carolina or Florida, officials said. They must meet National Sanitation Foundation standards for use in drinking water.

The fluoride is added to drinking water using precisely metered pumps at treatment plants, officials said.

The Cobb County-Marietta Water Authority serves nearly 1 million residents of Cobb, Douglas, Paulding and southern Cherokee counties. The authority stores hydrofluosilicic acid, a common fluoridating agent, in tanks at water treatment plants and adds it in liquid form to drinking water, Blackwell said. The electronically controlled metering pumps are calibrated daily and monitored around the clock, he said.

Water treatment plant operators leave the plant several times a day, 365 days a year, to test fluoride concentration in finished drinking water, Blackwell said.

Fluoride is added immediately after the water filtration process, Gwinnett County spokesperson Joe Sorenson said.

Goldstein, the Sandy Springs dentist, cautioned against removing fluoride from water supplies. Dental fillings need to be replaced every five to 10 years, further injuring teeth and leading to root canals and crowns, he said.

“That small cavity in childhood leads to serious dental work in adulthood,” he said. “It’s like cancer — we are trying to prevent it before it happens.”