Utah has become the first state in the United States to ban the addition of fluoride to public drinking water. This move disregards the opposition of dentists and national health organizations, who warn that the ban will lead to medical problems, with a particularly severe impact on low-income groups. Republican Governor Spencer Cox signed the legislation on Thursday, prohibiting cities and communities from independently deciding whether to add fluoride to their water supply systems.
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03-31, 2025Florida, Ohio, and South Carolina are considering similar measures, while legislators in New Hampshire, North Dakota, and Tennessee have rejected such proposals. A bill in Kentucky that would make fluoridation optional has stalled in the state Senate. The American Dental Association has strongly criticized Utah's law, calling it a "reckless disregard for the oral health and well-being of voters."
The American Dental Association points out that tooth decay is the most common chronic disease in children. The U.S. Centers for Disease Control and Prevention states that fluoride can strengthen teeth and reduce tooth decay by replacing minerals lost during everyday wear and tear. "As a father and a dentist, it is frustrating that a proven public health policy, which exists for the greater good of the oral health of the entire community, is being dismantled based on distorted pseudoscience," said the association's president, Denver dentist Dr. Brett Kessler, in a statement.
The ban, which will take effect on May 7, pushes fluoride concerns, long considered a fringe viewpoint, into the mainstream. This comes just weeks after Robert F. Kennedy Jr., a skeptic of water fluoridation, was sworn in as U.S. Health Secretary. Kennedy stated in November that then-presidential candidate Donald Trump's administration would recommend that water systems across the country remove fluoride.
Governor Cox, who grew up and raised his children in a community without fluoridated water, recently likened it to government-mandated medication. Utah legislators also stated that the ban is a matter of personal health choice and that adding fluoride to water is too expensive. Florida's Surgeon General recommended against community water fluoridation last year, citing what he called "neuropsychiatric risks." This followed a federal judge ordering the U.S. Environmental Protection Agency to regulate fluoride in drinking water, as high levels of fluoride may pose risks to children's intellectual development.
Federal officials determined last year "with moderate certainty" that higher levels of fluoride exposure are associated with lower IQ scores in children. However, the National Toxicology Program's conclusion was based on studies with fluoride levels approximately twice the recommended limit for drinking water. Kessler stated that the amount of fluoride that can be added to water under federal guidelines is below the level considered problematic. The National Institutes of Health states that extremely high doses of fluoride that can cause illness are usually the result of rare accidents, such as accidentally swallowing fluoride used in dental clinics or improperly administering supplements to children. The agency said it is "virtually impossible" to get a toxic dose from standard levels of fluoride added to water or toothpaste.
However, communities sometimes exceed recommended levels due to naturally occurring higher levels of fluoride in some water sources. In 2011, officials reported that two out of five American adolescents had at least mild tooth streaking or spotting due to excessive fluoride. Since 2015, federal health officials have recommended a fluoridation level of 0.7 milligrams per liter of water. For the fifty years prior to that, the recommended upper limit was 1.2 milligrams per liter. The World Health Organization sets a safe limit for fluoride in drinking water at 1.5 milligrams per liter.
Adding low levels of fluoride to drinking water has long been considered one of the greatest public health achievements of the last century: one of the most cost-effective ways to prevent tooth decay on a large scale. In 1950, federal officials endorsed water fluoridation to prevent tooth decay, and they continued to promote it even after fluoride toothpaste brands became available a few years later. More than 200 million people in the United States, or nearly two-thirds of the population, receive fluoridated public water.
The Utah Dental Association says that fluoride in drinking water can reduce tooth decay by at least 25% for people of all ages. Opponents of Utah's restrictions on fluoridation warn that this will disproportionately and negatively affect low-income residents who may rely on fluoridated water as their only source of preventive dental care. Republican Representative Stephanie Gricius, the sponsor of the Utah legislation, acknowledged that fluoride has benefits but said that not adding it to the water is a matter of "personal choice."
An Associated Press analysis shows that of the 484 Utah water systems reporting data in 2024, only 66 fluoridated their water. The largest of these is the water system for Salt Lake City, the state's largest city. According to data from the U.S. Centers for Disease Control and Prevention, Utah ranked 44th in the nation in 2022 in terms of the percentage of residents receiving fluoridated water.
