Brett Kelman
In the wooded highlands of northern Arkansas, the place small cities have few dentists, water officers who serve greater than 20,000 folks have for greater than a decade overtly defied state legislation by refusing so as to add fluoride to the ingesting water.
For its refusal, the Ozark Mountain Regional Public Water Authority has acquired a whole bunch of state fines amounting to about $130,000, that are stuffed in a cardboard field and left unpaid, mentioned Andy Anderson, who’s against fluoridation and has led the water system for almost twenty years.
This Ozark area is amongst a whole bunch of rural American communities that face a one-two punch to oral well being: a dire scarcity of dentists and a scarcity of fluoridated ingesting water, which is broadly seen amongst dentists as some of the efficient instruments to stop tooth decay. But because the anti-fluoride motion builds unprecedented momentum, it could end up that the Ozarks weren’t behind the occasions in spite of everything.
“We will eventually win,” Anderson mentioned. “We will be vindicated.”
Fluoride, a naturally occurring mineral, keeps teeth strong when added to ingesting water, in response to the Centers for Disease Control and Prevention and the American Dental Association. But the anti-fluoride motion has been energized since a authorities report final summer season discovered a potential hyperlink between decrease IQ in kids and consuming quantities of fluoride which are greater than what’s really useful in American ingesting water. Dozens of communities have determined to cease fluoridating in latest months, and state officers in Florida and Texas have urged their water techniques to do the identical. Utah is poised to change into the primary state to ban it in faucet water.
Health and Human Services Secretary Robert F. Kennedy Jr., who has lengthy espoused fringe well being theories, has known as fluoride an “industrial waste” and “dangerous neurotoxin” and mentioned the Trump administration will advocate or not it’s faraway from all public ingesting water.
Separately, Republican efforts to increase tax cuts and shrink federal spending may squeeze Medicaid, which might deepen current shortages of dentists in rural areas the place many residents rely on the federal insurance coverage program for no matter dental care they’ll discover.
Dental consultants warn that the simultaneous erosion of Medicaid and fluoridation might exacerbate a disaster of rural oral well being and reverse a long time of progress towards tooth decay, notably for kids and people who hardly ever see a dentist.
“If you have folks with little access to professional care and no access to water fluoridation,” mentioned Steven Levy, a dentist and main fluoride researcher on the University of Iowa, “then they are missing two of the big pillars of how to keep healthy for a lifetime.”
Many already are.
Overlapping ‘Dental Deserts’ and Fluoride-Free Zones
Nearly 25 million Americans dwell in areas with out sufficient dentists — greater than twice as many as prior estimates by the federal authorities — in response to a recent study from Harvard University that measured U.S. “dental deserts” with extra depth and precision than earlier than.
Hawazin Elani, a Harvard dentist and epidemiologist who co-authored the research, discovered that many scarcity areas are rural and poor, and rely closely on Medicaid. But many dentists don’t settle for Medicaid as a result of funds will be low, Elani mentioned.
The ADA has estimated that solely a third of dentists deal with sufferers on Medicaid.
“I suspect this situation is much worse for Medicaid beneficiaries,” Elani mentioned. “If you have Medicaid and your nearest dentists do not accept it, then you will likely have to go to the third, or fourth, or the fifth.”
The Harvard research recognized over 780 counties the place greater than half of the residents dwell in a scarcity space. Of these counties, at the very least 230 even have principally or utterly unfluoridated public ingesting water, in response to a KFF evaluation of fluoride data published by the CDC. That means folks in these areas who can’t discover a dentist additionally don’t get safety for his or her tooth from their faucet water.
The KFF Health News evaluation doesn’t cowl your complete nation as a result of it doesn’t embrace non-public wells and 13 states don’t submit fluoride knowledge to the CDC. But amongst those who do, most counties with a scarcity of dentists and unfluoridated water are within the south-central U.S., in a cluster that stretches from Texas to the Florida Panhandle and up into Kansas, Missouri, and Oklahoma.
In the middle of that cluster is the Ozark Mountain Regional Public Water Authority, which serves the Arkansas counties of Boone, Marion, Newton, and Searcy. It has refused so as to add fluoride ever since Arkansas enacted a statewide mandate in 2011. After weekly fines started in 2016, the water system unsuccessfully challenged the fluoride mandate in state court docket, then misplaced once more on attraction.
Anderson, who has chaired the water system’s board since 2007, mentioned he want to problem the fluoride mandate in court docket once more and would argue the case himself if needed. In a cellphone interview, Anderson mentioned he believes that fluoride can hamper the mind and physique to the purpose of creating folks “get fat and lazy.”
“So if you go out in the streets these days, walk down the streets, you’ll see lots of fat people wearing their pajamas out in public,” he mentioned.
Nearby within the tiny, no-stoplight group of Leslie, Arkansas, which will get water from the Ozark system, the one dentist on the town operates out of a one-man clinic tucked behind an vintage retailer. Hand-painted lettering on the shop window advertises a “pretty good dentist.”
James Flanagin, a third-generation dentist who opened this clinic three years in the past, mentioned he was drawn to Leslie by the quaint charms and pleasant smiles of small-town life. But those self same smiles additionally reveal the unmistakable penalties of refusing to fluoridate, he mentioned.
“There is no doubt that there is more dental decay here than there would otherwise be,” he mentioned. “You are going to have more decay if your water is not fluoridated. That’s just a fact.”
Fluoride Seen as a Great Public Health Achievement
Fluoride was first added to public water in an American metropolis in 1945 and unfold to half of the U.S. inhabitants by 1980, in response to the CDC. Because of “the dramatic decline” in cavities that adopted, in 1999 the CDC dubbed fluoridation as one in every of 10 great public health achievements of the twentieth century.
Currently greater than 70% of the U.S. inhabitants on public water techniques get fluoridated water, with a really useful focus of 0.7 milligrams per liter, or about three drops in a 55-gallon barrel, in response to the CDC.
Fluoride can be current in fashionable toothpaste, mouthwash, dental varnish, and some food and drinks — like raisins, potatoes, oatmeal, espresso, and black tea. But a number of dental consultants mentioned these merchandise don’t reliably attain as many low-income households as ingesting water, which has an extra profit over toothpaste of strengthening kids’s tooth from inside as they develop.
Two latest polls have discovered that the most important share of Americans assist fluoridation, however a large minority doesn’t. Polls from Axios/Ipsos and AP-NORC discovered that 48% and 40% of respondents wished to maintain fluoride in public water provides, whereas 29% and 26% supported its removing.
Chelsea Fosse, an knowledgeable on oral well being coverage on the American Academy of Pediatric Dentistry, mentioned she apprehensive that misguided fears of fluoride would trigger many individuals to cease utilizing fluoridated toothpaste and polish simply as Medicaid cuts made it tougher to see a dentist.
The mixture, she mentioned, might be “devastating.”
“It will be visibly apparent what this does to the prevalence of tooth decay,” Fosse mentioned. “If we get rid of water fluoridation, if we make Medicaid cuts, and if we don’t support providers in locating and serving the highest-need populations, I truly don’t know what we will do.”
Multiple peer-reviewed research have proven what ending water fluoridation might appear like. In the previous few years, research of cities in Alaska and Canada have proven that communities that stopped fluoridation noticed important will increase in kids’s cavities when put next with comparable cities that didn’t. A 2024 study from Israel reported a “two-fold increase” in dental therapies for youths inside 5 years after the nation stopped fluoridating in 2014.
Despite the advantages of fluoridation, it has been fiercely opposed by some since its inception, mentioned Catherine Hayes, a Harvard dental knowledgeable who advises the American Dental Association on fluoride and has studied its use for 3 a long time.
Fluoridation was initially smeared as a communist plot towards America, Hayes mentioned, after which later fears arose of potential hyperlinks to most cancers, which have been refuted by means of in depth scientific analysis. In the ’80s, hysteria fueled fears of fluoride inflicting AIDS, which was “ludicrous,” Hayes mentioned.
More lately, the anti-fluoride motion seized on worldwide analysis that implies excessive ranges of fluoride can hinder kids’s mind growth and has been boosted by high-profile authorized and political victories.
Last August, a hotly debated report from the National Institutes of Health’s National Toxicology Program discovered “with moderate confidence” that publicity to ranges of fluoride which are greater than what’s current in American ingesting water is related to decrease IQ in kids. The report was primarily based on an evaluation of 74 research carried out in different international locations, most of which have been thought of “low quality” and concerned publicity of at the very least 1.5 milligrams of fluoride per liter of water — or greater than twice the U.S. advice — in response to this system.
The following month, in a long-simmering lawsuit filed by fluoride opponents, a federal judge in California said the potential hyperlink between fluoride and lowered IQ was too dangerous to disregard, then ordered the federal Environmental Protection Agency to take nonspecified steps to decrease that danger. The EPA began to attraction this ruling within the remaining days of the Biden administration, however the Trump administration might reverse course.
The EPA and Department of Justice declined to remark. The White House and Department of Health and Human Services didn’t reply to questions on fluoride.
Despite the National Toxicology Program’s report, Hayes mentioned, no affiliation has been proven so far between lowered IQ and the quantity of fluoride truly current in most Americans’ water. The court docket ruling might immediate further analysis carried out within the U.S., Hayes mentioned, which she hoped would lastly put the marketing campaign towards fluoride to relaxation.
“It’s one of the great mysteries of my career, what sustains it,” Hayes mentioned. “What concerns me is that there’s some belief amongst some members of the public — and some of our policymakers — that there is some truth to this.”
Not all consultants have been so dismissive of the toxicology program’s report. Bruce Lanphear, a kids’s well being researcher at Simon Fraser University in British Columbia, published an editorial in January that mentioned the findings ought to immediate well being organizations “to reassess the risks and benefits of fluoride, particularly for pregnant women and infants.”
“The people who are proposing fluoridation need to now prove it’s safe,” Lanphear told NPR in January. “That’s what this study does. It shifts the burden of proof — or it should.”
Cities and States Rethink Fluoride
At least 14 states up to now this 12 months have thought of or are contemplating payments that may carry fluoride mandates or prohibit fluoride in ingesting water altogether. In February, Utah lawmakers handed the nation’s first ban, which Republican Gov. Spencer Cox told ABC4 Utah he intends to signal. And each Florida Surgeon General Joseph Ladapo and Texas Agriculture Commissioner Sid Miller have known as for his or her respective states to finish fluoridation.
“I don’t want Big Brother telling me what to do,” Miller told The Dallas Morning News in February. “Government has forced this on us for too long.”
Additionally, dozens of cities and counties have determined to cease fluoridation prior to now six months — together with at the very least 16 communities in Florida with a mixed inhabitants of greater than 1.6 million — in response to information reviews and the Fluoride Action Network, an anti-fluoride group.
Stuart Cooper, government director of that group, mentioned the motion’s unprecedented momentum can be additional supercharged if Kennedy and the Trump administration comply with by means of on a advice towards fluoride.
Cooper predicted that almost all U.S. communities can have stopped fluoridating inside years.
“I think what you are seeing in Florida, where every community is falling like dominoes, is going to now happen in the United States,” he mentioned. “I think we’re seeing the absolute end of it.”
If Cooper’s prediction is correct, Hayes mentioned, widespread decay can be seen inside years. Kids’ tooth will rot of their mouths, she mentioned, regardless that “we know how to completely prevent it.”
“It’s unnecessary pain and suffering,” Hayes mentioned. “If you go into any children’s hospital across this country, you’ll see a waiting list of kids to get into the operating room to get their teeth fixed because they have severe decay because they haven’t had access to either fluoridated water or other types of fluoride. Unfortunately, that’s just going to get worse.”
Methodology: How We Counted
This KFF Health News article identifies communities with an elevated danger of tooth decay by combining knowledge on areas with dentist shortages and unfluoridated ingesting water. Our evaluation merged Harvard University analysis on dentist-shortage areas with giant datasets on public water techniques printed by the U.S. Centers for Disease Control and Prevention.The Harvard research decided that almost 25 million Americans dwell in dentist-shortage areas that span a lot of rural America. The CDC data particulars the populations served and fluoridation standing of greater than 38,000 public water techniques in 37 states. We categorized counties as having elevated danger of tooth decay in the event that they met three standards:More than half of the residents dwell in a dentist-shortage space recognized by Harvard.The variety of folks receiving unfluoridated water from water techniques primarily based in that county quantities to greater than half of the county’s population.The variety of folks receiving unfluoridated water from water techniques primarily based in that county quantities to at the very least half of the full inhabitants of all water techniques primarily based in that county, even when these techniques reached past the county borders, which many do.
Our evaluation recognized roughly 230 counties that meet these standards, which means they’ve each a dire scarcity of dentists and largely unfluoridated ingesting water.
But this complete is definitely an undercount. Thirteen states don’t report water system knowledge to the CDC, and the company knowledge doesn’t embrace non-public wells, most of that are unfluoridated.
KFF Health News knowledge editor Holly Ok. Hacker contributed to this text.
