Ask PolitiFact: What does Florida’s move to ban fluoride mean for public health?

As a Florida bill banning fluoride in tap water awaits Gov. Ron DeSantis’ approval, oral health advocates warn the move signifies a major public health setback.

If DeSantis signs SB 700 into law, Florida will join Utah as the second state to eliminate the cavity-preventing mineral from public drinking water. Several other states are considering similar legislation, including Tennessee, Connecticut and Kentucky. Hawaii has never mandated water fluoridation and it is provided only at its military bases, according to KFF and NPR.

The U.S. Centers for Disease Control and Prevention has long touted the advent of fluoridated drinking water as one of the greatest public health achievements of the 20th century; the CDC said fluoridated water provides "a practical, cost-effective, and equitable way for communities to improve their residents’ oral health regardless of age, education, or income." With more than 6,900 studies or reports on fluoridation, fluoride is one of the most researched topics in public health, the American Academy of Pediatrics found.

But leaders like DeSantis, Florida Surgeon General Dr. Joseph A. Ladapo and newly appointed U.S. Health and Human Services Secretary Robert F. Kennedy Jr. challenged the premise that fluoride is a public good.

DeSantis pushed to ban the mineral in the state’s drinking water, calling it "forced medication" and pointing to what he describes as fluoride's potential health risks for pregnant women and children. 

Ladapo in 2024 advised Florida’s communities to stop adding fluoride to drinking water. Kennedy recently directed the CDC to cease recommending it as well, after misleadingly linking it to cancer and other diseases and disorders. 

Florida’s SB 700 is a broad agriculture bill that, among other things, prohibits flying drones in land classified as agricultural and requires local governments to issue permits for electric vehicle charging stations. It prohibits the use of water additives that aim to improve water quality without explicitly mentioning fluoride. 

With conflicting statements about fluoride’s safety driving policies in Florida and other states, we sought to answer some basic questions about the mineral’s history in public water systems, health concerns and benefits, and options for people who want to keep their access.

Why is fluoride used in public water systems?

Research over nearly 90 years has concluded that fluoride helps prevent tooth decay and cavities. It strengthens tooth enamel that acid from bacteria, plaque and sugar can wear away.

Scientists in the 1940s detected that people in areas where water supplies included higher levels of naturally occurring fluoride had lower rates of dental decay than those in areas without fluoridated water. Building on that research, Grand Rapids, Michigan, in 1945 became the first U.S. city to add fluoride to its water supply, setting the concentration level at 1.0 parts per million.

The effort caught on. By 1954, fluoridated water was reaching the homes of more than 20 million people in the U.S., according to the CDC. By 2020, it reached about 209 million people.

A 2018 study cited by the National Institutes of Health found that children living in a county in which 75% or more of the drinking water contained at least 0.7 milligrams per liter of fluoride experienced a 30% reduction in the rate of primary teeth decay and a 12% reduction in permanent teeth decay.

Does fluoride pose a health risk? 

Ingesting fluoride at concentrations higher than what’s recommended in the U.S., can lead to what’s known as dental fluorosis, which changes how teeth look, causing white flecks, spots, lines or brown stains on the teeth.

The risk is eliminated at lower fluoride concentrations, research shows. In 1962, the federal Public Health Service recommended community water systems provide tap water fluoridation at levels ranging from 0.7 milligrams per liter to 1.2 milligrams per liter. In 2015, the U.S. Department of Health and Human Services recommended 0.7 milligrams per liter as the optimal concentration level to avoid discoloration— a level endorsed by the CDC, American Dental Association, American Academy of Pediatrics and the Florida Dental Association.

Other health risks associated with fluoride also stem from exposure to much higher-than-recommended levels. One of them is skeletal fluorosis, a rare condition that causes weaker bones, stiffness and joint pain. The Environmental Protection Agency, which sets enforceable standards for drinking water quality, requires that water systems not exceed 4 milligrams of fluoride per liter of water in order to prevent skeletal fluorosis. 

In 2024, Lapado highlighted a federal review of dozens of studies that concluded that higher levels of fluoride exposure were linked to  lower children’s IQs. But the report was based primarily on studies in other countries where fluoride levels were  at or above 1.5 milligrams per liter, twice the recommended U.S. limit. 

He also cited a 2024 study by University of Florida and University of Southern California researchers that found a link between fluoride exposure during pregnancy and an increased risk of childhood neurobehavioral problems. It said more studies were "urgently needed to understand and mitigate the impacts in the entire U.S. population."

Health experts told PolitiFact that prenatal fluoride exposure is most strongly linked to children’s IQ loss, and timing of fluoride consumption might need to be considered in future recommendations.

Despite Kennedy’s past claims of a link between water fluoridation and cancer, health experts and scientists from the U.S. and other countries have so far "not found convincing scientific evidence linking community water fluoridation with any potential adverse health effect or systemic disorder such as an increased risk for cancer, Down syndrome, heart disease, osteoporosis and bone fracture, immune disorders, low intelligence, renal disorders, Alzheimer disease, or allergic reactions," the CDC’s Agency for Toxic Substances and Disease Registry says.

Bruce Dye, professor and chair of the Department of Community Dentistry and Population Health at the University of Colorado School of Dental Medicine, compared adding fluoride in drinking water with the benefits of adding folic acid to grain products to prevent birth defects and to adding Vitamin D to milk to improve calcium absorption to prevent weakened bones.

"We do these public health activities to help our children and the most vulnerable who have limited or no voice to have access to a better quality of life," Dye said.

What is the history of anti-fluoride efforts?

The early years of fluoridation efforts coincided with Cold War tensions, which sparked conspiracy theories about mind-altering substances in the water.

In the 1960s, the John Birch Society, a right-wing political advocacy group, alleged that communists had infiltrated the U.S. government and made fluoride part of their communist plot for mind control or chemical weaponry, Matthew Dallek, a political historian at the George Washington University, told NPR in 2024. The satirical 1964 movie "Dr. Strangelove" parodied anti-fluoridation paranoia in the character of a general who starts a nuclear war because he believes Russians have invaded the U.S. and used fluoride to poison the water.

Colgate toothpaste on a Colgate Total toothbrush is shown Oct. 28, 2009 in Marysville, Pa. (AP)

What about fluoride in toothpastes and foods?

Some dental products such as toothpaste and mouthwash contain fluoride. Large amounts of the mineral can be toxic, but it’s difficult to reach toxic levels of fluoride using over-the-counter products. Florida’s water legislation doesn’t deal with these products.

To avoid overconsumption of fluoride in children, the CDC recommends minimal fluoride use for children under 6. — just a grain-sized smear of toothpaste for kids under 3 and a pea-sized smear between ages 3 to 6. Parents are advised to teach children not to swallow the toothpaste.

The National Institutes of Health reports that only small traces of fluoride are naturally present in most foods and that the foods prepared with fluoridated water provide less than 0.05 mg.

If DeSantis signs the bill into law, how quickly would that affect Floridians’ tap water?

SB 700 would take effect July 1.

About 70% of Florida’s community water systems are fluoridated, according to 2023 state data. (Here is the state’s list of municipalities that treat water with fluoride.)

Florida Dental Association President Jeff Ottley said recent studies out of Canada show that communities that remove fluoride in water experience decreased dental health, including a 25% to 50% increase in cavities, especially in underserved areas. 

Miami Mayor Daniella Levine Cava on April 11 vetoed the Miami-Dade County Commission’s resolution to end public water fluoridation; the commission could vote May 6 to override her veto.  Other local Florida governments have also voted whether to end water fluoridation. Cities that removed fluoridation include Stuart, Fort Pierce, Tavares, Port St. Lucie and Naples.

What options do I have to fluoridate my water if my local water system eliminates the additive?

Florida’s bill overrides local governments’ efforts to fluoridate water.

If fluoridated water is not available in your area, the CDC recommends obtaining fluoride from dental products such as toothpaste and mouth rinse. Dentists and doctors can also prescribe oral fluoride supplements such as drops, tablets or lozenges. 

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