When I was learning about water fluoridation in dental school nearly two decades ago, I was skeptical about the benefits. Then, when I started my career, I was practicing in a fluoridated county that bordered a non-fluoridated county. I saw patients from both.
When a patient sat down in my chair, I knew instantly which area they lived in. The differences were stark, drastic, and immediately convincing of the power of fluoridated water.
Public water fluoridation is lauded as one of the top public health achievements of the 20th century,1 with benefits recognized by the ADA, CDC, and WHO. It’s a measure that helps everyone, regardless of age, race, nationality, income, access to care, or geographic location; fluoridated water is an equal opportunity advantage for all.
Fluoride is a naturally occurring mineral in water. Since the 1940s, municipalities have been controlling the amount in public drinking water supplies to help reduce tooth decay. The caries prevented by doing so surely tallies in the billions.
Yet, we find ourselves at a time when this public health benefit is under attack across the U.S.
Florida2 and Utah3 have already stopped public water fluoridation and similar actions have been discussed in other states, including Ohio4 and Arkansas.5
Regardless of the status of your water fluoridation where you practice, there are key steps we dental professionals can take to ensure fluoride continues to positively impact oral health in the U.S.
Impacts to communities
The impacts of halting water fluoridation are seen in several regions, notably Calgary, Canada. Less than a decade after Calgary stopped fluoridation, 65% of children observed showed signs of tooth decay, compared to 55% in Edmonton, where water continues to be fluoridated.6 Calgary also saw a 78% increase in general anesthesia use to treat young children with severe dental decay after fluoridation stopped.7,8
Calgary reversed course and reintroduced fluoridation in June of this year.
The Journal of the American Medical Association (JAMA) published projected impacts of removing fluoride from U.S. water supplies. Over a 5-year period, the JAMA model estimates a 7.5% increase in tooth decay in children, costing an estimated $9.8 billion.9
The study says defluoridation and resulting increase in tooth decay “would disproportionately affect publicly insured and uninsured children compared to those with private dental insurance.”
What dentists can do
For dentists practicing in areas with fluoridated water, do everything you can to ensure it remains. This starts with patient conversations.
Much of the fervor behind the effort to stop fluoridation could be subdued with proper education and understanding. States and local governments balance the naturally occurring fluoride to provide a safe level of fluoride that benefits oral health. A 2025 JAMA Pediatrics Review and Meta-Analysis connected exposure to fluoride with a decrease in the IQs of children,10 but the exposure levels in this study were near double what is accepted as safe, and significantly higher than the levels found in the vast majority of U.S. water supplies. However, when many patients see this information, it’s framed as “fluoride in water is lowering IQs in children.”
Conversations with patients can compound throughout the community. A well-informed community can help counter misinformation before it gains traction and, hopefully, stop misguided political efforts to remove fluoride from public water systems altogether.
If politicians have started the debate about fluoride in your area, contact your local trade groups and universities and organize with groups of dentists in support of fluoridation. Make your voices heard. Request time with your mayors and governors. Make sure they understand the gravity of the situation and the detriment to their constituents.
For those of us in Florida and Utah, the latter being where I practice and work as the Director of Clinical Affairs for Ultradent Products, we’ve already reached a point where public support isn’t enough, and we’ve lost access to fluoridated public water supplies. We must stress to our patients the importance of supplementing the fluoride they’ve lost, whether that’s through fluoride varnish treatments or fluoride tablet prescriptions, the latter of which the FDA is also now looking into restricting.10
For many patients, fluoride varnish treatments will be their best option. For dentists, it’s increasingly important to ensure we are providing our patients with the most effective treatments. When comparing fluoride varnish options, it is important to evaluate fluoride uptake into sound enamel instead of demineralized enamel. Fluoride concentration is itself a critical aspect of a varnish, but what really matters is if that fluoride gets transferred to the enamel.
Options like fluoride varnish treatments only work for patients who are coming into our offices. All too often, low-income children who will be most impacted by losing fluoridated water aren’t the ones who will be sitting in our chairs. We will have to engage with those patients through increased community outreach and humanitarian efforts.
Participation in events like Give Kids a Smile Day, where we can do fluoride varnish applications and provide education, will be even more impactful than they’ve previously been. Many schools also have programs where we can achieve the same goals. Find these outlets in your community and look to help. If they don’t already exist, partner with your local dentists and organizations to make them a reality.
Protecting a public health pillar
Millions of Americans have already lost access to the proven public health benefits of fluoridated water, with tens of millions more at risk of losing it in coming months or years. We must do all we can to mitigate the impacts of these policy decisions on the health of our patients.
Informative conversations, community outreach, humanitarian work, and selecting the most effective products are steps the dental community can take to help preserve the benefits of fluoride for oral health.
A core pillar of American oral health is at risk we need the dental industry united, as a whole, to preserve it.
References
Centers for Disease Control and Prevention (CDC). Ten great public health achievements — United States, 1900-1999. MMWR Morb Mortal Wkly Rep. 1999 Apr 2;48(12):241-243. Accessed October 29, 2025. https://www.cdc.gov/mmwr/preview/mmwrhtml/00056796.htm
Anderson O. Florida second state to ban community water fluoridation. ADA News. May 15, 2025. Accessed October 29, 2025. https://adanews.ada.org/ada-news/2025/may/florida-second-state-to-ban-community-water-fluoridation/
Anderson O. Utah becomes first state to ban community water fluoridation. ADA News. March 28, 2025. Accessed October 29, 2025. https://adanews.ada.org/ada-news/2025/march/utah-becomes-first-state-to-ban-community-water-fluoridation/
NBC4i. Ohio lawmakers debate whether to ban fluoride from public drinking water. NBC4i. [Date unknown]. Accessed October 29, 2025. https://www.nbc4i.com/news/politics/ohio-lawmakers-debate-whether-to-ban-fluoride-from-public-drinking-water/
KATV News. Arkansas lawmakers debate local control over fluoride in water amid health concerns. KATV. [Date unknown]. Accessed October 29, 2025. https://katv.com/news/local/arkansas-lawmakers-debate-local-control-over-fluoride-in-water-amid-health-concerns
What happened when Calgary removed fluoride from its water supply? PBS NewsHour. [Date unknown]. Accessed October 29, 2025. https://www.pbs.org/newshour/show/what-happened-when-calgary-removed-fluoride-from-its-water-supply?utm_source=chatgpt.com
O’Neill B, Kapoor T, McLaren L, et al. Politics, science, and termination: a case study of water fluoridation policy in Calgary in 2011. Rev Policy Res. 2018;36(1):99-120. Accessed October 29, 2025. https://link.springer.com/article/10.17269/s41997-024-00858-w?utm_source=chatgpt.com
Anderson O. JAMA releases study on elimination of community water fluoridation. ADA News. May 2025. Accessed October 29, 2025. https://adanews.ada.org/ada-news/2025/may/jama-releases-study-on-elimination-of-community-water-fluoridation-7/?utm_source=chatgpt.com
Choi SE, Simon L. Projected outcomes of removing fluoride from US public water systems. JAMA Health Forum. 2025;6(5):e251166. Accessed October 29, 2025. https://jamanetwork.com/journals/jama-health-forum/fullarticle/2834515?widget=personalizedcontent&previousarticle=0
McLaren L, Patterson SK, Faris P, et al. Community water fluoridation cessation and children’s dental caries: A 7-year follow-up evaluation of Grade 2 schoolchildren in Calgary and Edmonton, Canada. JAMA Pediatrics. 2025;[epub ahead of print]. Accessed October 29, 2025. https://jamanetwork.com/journals/jamapediatrics/fullarticle/2828425
U.S. Food & Drug Administration. FDA begins action to remove ingestible fluoride prescription drug products for children from the market. May 13, 2025. Accessed October 29, 2025. https://www.fda.gov/news-events/press-announcements/fda-begins-action-remove-ingestible-fluoride-prescription-drug-products-children-market
