Bans on water fluoride divide communities
MONROE, N.C. – Regina Barrett, a 69year-old retiree who lives in Monroe, North Carolina, southeast of Charlotte, is not happy with her tap water. “Our water has been cloudy and bubbly and looks milky,” said Barrett.
She blames fluoride, a mineral that communities have for decades added to the water supply to help prevent cavities and improve dental health.
“I don’t want fluoride in my nothing!” said Barrett, “I’m suspicious as to why they add that to our water.”
Her reaction echoes that of a growing number of people who not only doubt the mineral’s effectiveness but also believe it may be harmful despite decades of data pointing to public health and economic benefits.
In February, the commissioners in the county where Barrett lives voted 3-2 to stop adding fluoride to drinking water at the Yadkin River Water Treatment Plant, the only water source wholly owned and operated by the county. The decision came after heated discussions in packed rooms among residents and county officials.
“My children had the blessing of growing up with fluoride in their water and … they have very little dental issues,” said Commissioner Richard Helms. A man who spoke during public comment compared water fluoridation to a seat belt: It doesn’t “prevent the car crash, but it limits the harm done,” he said.
But a fellow commissioner saw it differently: “Let’s stop putting something in the water that’s meant to treat us, and give people the freedom to choose,” said David Williams. And a resident argued that there is no proof fluoride is safe or effective, and called on the commission “to reverse 60-plus years of poisoning the public.”
It is a scenario playing out nationwide. From Oregon to Pennsylvania, hundreds of communities have in recent years either stopped adding fluoride to their water supplies or voted to prevent its addition.
The outcome of an ongoing federal case in California could force the Environmental Protection Agency to create a rule regulating or banning the use of fluoride in drinking water nationwide. In the meantime, the trend is raising alarm bells for public health researchers who worry that, much like vaccines, fluoride may have become a victim of its own success.
The arguments
Supporters of fluoride bans argue that people should be given the freedom of choice. The broad availability of overthe-counter dental products containing the mineral makes it no longer necessary to add to public water supplies, they say.
The Centers for Disease Control and Prevention says that the greatest protection comes when store-bought products are used in combination with water fluoridation. Public health officials say removing fluoride could be particularly harmful to low-income families – for whom drinking water may be the only source of preventive dental care.
Millions of people have lived with fluoridated water for years, “and we’ve had no major health problems,” said dentist Myron Allukian Jr., past president of the American Public Health Association.
“It’s much easier to prevent a disease than to treat it.”
Fluoride opponents claim the mineral is responsible for everything from acne to high blood pressure to thyroid dysfunction to bone cancer. A Canadian study published in JAMA Pediatrics in 2019 associated fluoride exposure during pregnancy with lower IQ scores in children. But the study was based on self-reporting and has been criticized for its perceived methodological shortcomings.
The National Institutes of Health acknowledges that, when ingested in extremely large amounts, fluoride from dental products or dietary supplements can cause nausea, vomiting, abdominal pain, diarrhea, bone pain and even death in extremely rare cases.
However, the recommended dosage in drinking water has always been small. In 2015, the Department of Health and Human Services lowered the optimal fluoride concentration from 1.2 milligrams per liter to 0.7 milligrams.
Decisions around the country
Juneau, Alaska, voted to remove fluoride from its drinking water in 2007. A study published in the journal BMC Oral Health in 2018 compared the dental records of children and adolescents who received dental care for decaying teeth four years before and five years after the city stopped adding fluoride to the water. Cavity-related procedures and treatment costs were significantly higher in the latter group, the study found.
Despite the strong recommendation of local doctors and dentists, voters in Wichita, Kansas, have rejected adding fluoride to the water several times, most recently in 2012.
Portland, Oregon, is the largest city in the nation that has consistently refused to fluoridate its drinking water. Voters have repeatedly rejected measures to add it, first in 1956 and the latest time in 2013.
In 2016, Collier County, Florida, commissioners opted not to remove fluoride from the water system. But they unanimously reversed that decision following a 2023 Health Freedom Bill of Rights county ordinance in response to COVID-19 “to safeguard the healthcare rights and freedoms of Collier County residents.”
Also in 2016, several consumer advocacy groups petitioned the EPA to end water fluoridation under the Toxic Substances Control Act. After the agency denied their citizen petition, the same groups filed a federal lawsuit against the EPA the following year.
During a 10-day bench trial in San Francisco that concluded in mid-February, the two sides debated the risks and areas of uncertainty. If senior U.S. District Judge Edward Chen determines water fluoridation presents an “unreasonable risk” to human health, the EPA will be forced to create a rule regulating or banning water fluoridation in the U.S. A decision is expected soon.
Barrett, the North Carolina retiree, lives in a house whose water comes from the City of Monroe, not the Yadkin facility. So she will continue to drink water enhanced with fluoride as, for the time being, fluoridation decisions are made primarily at the local level.
She hopes that will change.
“Of all things, they want our teeth healthy when basic needs of housing and food are lacking,” Barrett said.
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