Yes, Fluoride in Your Drinking Water Is a Good Thing
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If you’ve got a mouthful of healthy teeth, you can probably thank some kind of combo of good genes, a solid brushing routine—and the presence of fluoride in your drinking water. Since the 1940s, adding the mineral to the public water supply has been the norm in many places throughout the US. So, depending on where you live and what your source is, you may be downing the cavity-cutting compound with every glass of tap.
But according to prospective US Department of Health and Human Services (HHS) head Robert F. Kennedy Jr., that needs to change: He made headlines after declaring on X back in November that the Trump administration will immediately push to do away with water fluoridation. Not that he’s the first or only naysayer, to be fair. Fluoride skepticism is nothing new, Nicole Deziel, PhD, MHS, an associate professor of epidemiology at the Yale School of Public Health, tells SELF. In fact, “there have been various urban legends and conspiracy theories” circulating for decades, Dr. Deziel says.
Just why are some people so suspicious of fluoride? And is there any legitimacy to their concerns? With misinformation running rampant on the internet, we set out to home in on the actual facts. Read on to find out what fluoride is, what it does, how it’s wielded as a public health tool, and, yes, why it’s controversial in some (non-expert) circles.
What is fluoride in the first place?
Fluoride is a naturally occurring mineral that is present at low levels in almost all water. Typically, it ends up in that water via natural processes like rock and soil weathering, but human activities like manufacturing can also contribute, Dr. Deziel says.
Certain foods and beverages naturally contain fluoride too: Shellfish can accumulate it in their shells and muscles, for example, and the plants used to produce black tea and coffee absorb the mineral from the soil. That said, people take in the majority of their fluoride via sources where the mineral is purposefully added: water and toothpaste.
Currently, the HHS recommends a fluoride concentration of 0.7 milligrams per liter of drinking water, though the EPA enforces a maximum limit of 4 mg/L. Per CDC data, 63% of the US population received fluoridated water as of 2020.
What are the benefits of fluoride?
Here are a few reasons why we might want to think twice before removing fluoride from public drinking water.
1. It protects your oral health.
Fluoridated water benefits your teeth in two main ways, Bill Sullivan, PhD, a microbiologist and professor at the Indiana University School of Medicine, tells SELF. First, it has chemical properties that help support and strengthen enamel, the hard outer layer of a tooth that acts as a protective covering. “Enamel is one of the most critical parts of a tooth’s health because it helps to prevent decay,” Dr. Sullivan says.
Second, it acts as an antimicrobial, meaning it defends against harmful bacteria in the mouth. “Bacteria are the causative agent behind plaque, and they produce acid that can make holes in teeth, and that can spawn into cavities as well as gum disease,” Dr. Sullivan says.
Ultimately, fluoridated water can improve your overall oral health by helping prevent cavities and reversing them in the early stages. And that’s important, since cavities can cause pain, toothache, tooth sensitivity, infection, tooth loss, as well as aesthetic issues like pitting and discoloration. In rare cases, a cavity can develop into a severe type of infection known as an abscess, which can be life-threatening if it’s not treated quickly.
Some research also suggests that fluoridated water may also have a protective effect against periodontal disease (a.k.a gum disease)—conditions involving inflammation and infection of the gum and bone tissues around the teeth, and the leading cause of tooth loss besides decay. For example, a 2024 study published in the Journal of Pharmacy & BioAllied Sciences found that people living in fluoridated-water communities had better periodontal health than folks whose water didn’t contain the added mineral.
2. And that supports your overall health too.
Tooth decay and gum disease have repercussions that can extend well beyond your mouth. In fact, the list of conditions linked to poor oral health includes cancer, diabetes, osteoporosis, Alzheimer’s, cardiovascular disease, rheumatoid arthritis, obstructive sleep apnea, and many more, per the American Academy for Oral Systemic Health.
Another far-reaching benefit of fluoride: It can help strengthen your bones. In trace amounts, fluoride plays a key role in normal bone development throughout your entire body. Specifically, it stimulates bone-building cells known as osteoblasts as well as hormones like insulin-like growth factor. For that reason, a chronic fluoride deficiency can cause weak and brittle bones, especially in children.
3. Finally, better oral health can even improve your life in non-physical ways.
Your teeth are a hypervisible part of your body, so it makes sense that dental problems can cause you to feel self-conscious or shy away from social situations, which can all take a serious toll over time. Yep, that’s right, oral issues like gum disease or tooth decay aren’t only risky from a physical health standpoint—they can also snowball into social or mental health struggles, according to Dr. Deziel. Children who are affected might experience “difficulty concentrating, poor school performance, social stigma, a host of other issues,” she says.
Why is it added to drinking water?
Simply put: Fluoride is added to drinking water to prevent tooth decay. In the first half of the 20th century, dentists noticed a link between fewer cavities and drinking water that naturally contained higher amounts of fluoride. Back then, tooth decay was more widespread, according to Dr. Deziel, so this finding was a big deal.
In most cases, though, the fluoride levels naturally occurring in water were too low to prevent cavities. So beginning in the 1940s, cities and towns began introducing fluoride to public water sources “as an effective and inexpensive solution to try to reduce cavities,” Dr. Deziel says. “The benefits were really profound.” Dental health started improving rapidly in communities across the country. In 1962, the US Public Health Service formally recommended the intervention, and by 1999, its success was so clear that the CDC even named water fluoridation as one of the 20th century’s 10 great public health achievements.
Since fluoride’s introduction into the water supply, dental care has advanced significantly and oral care products that contain fluoride (like toothpaste and mouth rinses) have emerged, so the benefits are less pronounced, according to Dr. Deziel. But that doesn’t mean they’re not still present. Here in the US, “fluoridated products and good dental care are not affordable and accessible to everyone,” Dr. Deziel says, so water fluoridation “really is an important public health measure to address disparities in dental insurance, access to dental care, and regular dental hygiene.”
On average, US communities that have access to fluoridated water experience 25% fewer cavities, according to the CDC. To put that in perspective, providing “optimally fluoridated water” for one year saves $6.5 billion in dental treatment costs.
“Fluoridating our public water supply is really cheap to do, and it is extremely helpful for these lower income-communities to maintain good oral hygiene,” Dr. Sullivan says.
So what’s the controversy over fluoride in our drinking water?
In RFK Jr.’s post on X, he called fluoride “an industrial waste associated with arthritis, bone fractures, bone cancer, IQ loss, neurodevelopmental disorders, and thyroid disease.”
Let’s dig into some of these claims. Overall, “these statements have an element of truth, but can be misunderstood without the appropriate context or nuance,” Dr. Deziel says. First, keep in mind that the dose matters. In other words, anything can be toxic in a large enough quantity. “Water’s obviously an essential ingredient to life, but you can drink so much water that it can actually be lethal,” Dr. Sullivan points out. Similarly, “both too much and too little fluoride can create health problems,” Dr. Deziel says. Too little fluoride can cause dental issues like cavities, as we’ve already established. On the other hand, “prolonged exposure to very high levels of fluoride can actually be harmful to teeth and bones,” causing issues like bone fractures and osteoarthritis, Dr. Deziel says.
As for some of RFK Jr.’s other claims? “While studies looking at other end points such as bone cancer and thyroid issues exist, the current evidence base is weak and limited,” Dr. Deziel says. Besides, she adds, “Many of the health risks listed require prolonged exposure to levels much higher than those typically found in drinking water.”
What’s more, many of the studies showing a link are highly preliminary—for instance, performed in test tubes or mouse models—and suggest correlation rather than causation, according to Dr. Sullivan. Even the human studies have issues that may call their conclusions into question, like a small sample size, a very high fluoride level, or a failure to take into account factors like diet or fluorinated product use, too, Dr. Sullivan says. Others “show very modest effects, are contradicted by other studies, or have yet to be repeated by an independent group.”
Take, for instance, this 2024 meta-analysis published in Plos One. While its review of seven studies did suggest a potential link between chronic high levels of fluoride exposure and thyroid damage, the authors also caution that “every study was found to have major or minor methodological issues and significant risk of bias,” and in general, “the overall confidence in the evidence was deemed low for all outcomes.” As for the link between fluoride and children’s cognition? According to the National Toxicity Program, while high levels were associated with lower IQ in kids, there were “insufficient data” to determine if that relationship still persisted at the lower fluoride levels recommended by the CDC. While this evidence is emerging rather than conclusive—meaning we can’t yet say for certain if there is any cause and effect there—it does raise questions that are worth looking into further, according to Dr. Deziel. That way, “we could still achieve the dental benefits and public health benefits, but also minimize these potential other consequences related to neurological effects.”
But on balance, the available research simply doesn’t support purging fluoride from public drinking water. Far from it, in fact. Water fluoridation “serves an important public health role,” Dr. Deziel says. “We shouldn’t eliminate fluoridation entirely, but rather examine the scientific evidence to ensure we’re targeting the correct concentrations and limits.”
The bottom line
Overall, water fluoridation has been a massive boon to public health in the US. Given its proven benefits, taking a scorched-earth approach like eliminating fluoride entirely would do far more harm than good, according to Dr. Sullivan. “We know for a fact that it is going to cause suffering and cost people a lot of money,” he says. “This is a cost-benefit ratio, and the cost of removing fluoride from the water is going to be catastrophic for dental health.”
Related:
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Originally Appeared on Self
