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The science seems settled.
After thousands of studies over the course of decades, it’s been shown that the presence of a small amount of fluoride, a mineral added in drinking water (the U.S. Public Health Service currently recommends a level of 0.7 parts per million), inhibits tooth decay.
In 1945, Grand Rapids, Michigan, was the first American city to add fluoride to its city water. Today, 67.1% of Americans have access to fluoridated water. In Virginia, 96% of public water supplies are fluoridated, including Richmond, Henrico and Chesterfield counties.
Adding fluoride to community water supplies is a health recommendation, not a mandate, according to the U.S. Centers for Disease Control and Prevention, but the practice has drawn criticism almost since its inception. For example, in the 1950s, the John Birch Society called the practice “a massive wedge for socialized medicine,” according to a Nov. 3 report on National Public Radio’s “All Things Considered.”
“On the whole, there has been very little pushback on water fluoridation; the science supporting it is strong,” says Sarah Bedard Holland, CEO of the health advocacy nonprofit Virginia Health Catalyst. The group seeks to promote equitable access for Virginians to comprehensive health care, including dental care. Fluoridation of public water provides universal access to oral health care, she says.
In November, the incoming presidential administration’s nominee for Health and Human Services secretary, Robert Kennedy Jr., posted on social media outlet X that, “On January 20th, the Trump White House will advise all water systems to remove fluoride from public water.”
Overexposure to fluoride can lead to brown staining of the enamel, known as mottling, according to the CDC. In the social media post, Kennedy claimed that the mineral is an industrial waste and said it was associated with ailments ranging from arthritis to thyroid diseases.
Virginia Health Catalyst’s Holland sees the anti-fluoridation voices gaining public attention as a sign of water fluoridation’s impact and safety. “[In] some ways, because of its quiet effectiveness, it has fallen off most people’s radar screens,” she says. “I think we have an opportunity now, since fluoride is getting attention, to laud its successes and revisit its purpose, effectiveness and necessity.”
To that end, she shares in an email, the nonprofit will continue to offer evidence-based information about fluoridation and other oral health practices.
In a letter sent Nov. 15 to friends of Virginia Health Catalyst, she noted that fluoridation has been shown to reduce the rate of cavities in adults and children by 25%.
The letter also noted that water fluoridated at levels two or three times the optimal amount has been associated with joint pain and nausea. At even higher rates of consumption, it has been associated with lower IQ in children, according to a systematic review of research by the National Toxicology Program.
Studies in the U.S., she writes, show no risk of high fluoride exposure from municipal systems. “As with any substance, dose matters, and the fluoride levels used in U.S. water systems are well within the range deemed safe by health authorities,” she writes.
Tegwyn Brickhouse, a professor of pediatric dentistry for the VCU School of Dentistry and a board member of Virginia Health Catalyst, says water fluoridation is a safe and effective public health measure. “Community water fluoridation is one practical way to help everyone — especially those facing barriers to care — avoid unnecessary suffering and expenses,” she says.
“Untreated oral health problems don’t just cause pain — they can make it harder for children to learn, keep adults from working, and, over time, lead to serious health complications. Meanwhile, too many Virginians don’t have regular access to a dentist or the necessary resources to maintain strong, healthy teeth.”
Richmond Mayor Danny Avula says the city needs to be aware of any changes in federal policies, but Richmond public welfare needs to drive any decision. “The call for local leaders is to protect and support healing and thriving in our community, and that means really looking out for the best interests of people here in Richmond,” Avula says. “[We] control the water supply, and so we do have local decision-making, authority and autonomy around things like that.”
About Fluoride
The mineral fluoride combines with outer enamel layers on teeth, hardening the enamel, which makes teeth less susceptible to decay. Fluoride is present in most water. Many public water supplies add fluoride to ensure recommended therapeutic levels. The presence of fluoride at optimal levels reduces the occurrence of cavities by 25% in adults and children.
Fluoride in Metro Richmond Water
Chesterfield County: 0.78 fluoride parts per million
Henrico County: 0.70 fluoride parts per million
Richmond City water: 0.60 fluoride parts per million
Find information on fluoride levels in water systems at cdc.gov/fluoridation.
Sources: U.S. Centers for Disease Control and Prevention, National Institutes of Health, Virginia Health Catalyst, City of Richmond, Chesterfield County, Henrico County
