In the charming town of Monroe, North Carolina, 69-year-old retiree Regina Barrett has been feeling uneasy about her tap water. She describes it as cloudy, fizzy, and sometimes even milky. Barrett blames fluoride, a mineral added to water supplies across the nation for years to improve dental health and prevent cavities. “I don’t want fluoride in my water!” Barrett declares firmly, echoing the sentiments of a growing number of individuals. This group not only questions the effectiveness of fluoride but also harbors concerns about its potential harm, despite decades of data highlighting its public health benefits.
Local Decision, Countywide Impact
In February, the Board of County Commissioners in Union County, where Monroe is located, voted 3-2 to stop adding fluoride to the water at the Yadkin River Water Treatment Plant, the county’s only water source under its ownership. However, this decision followed heated debates among residents and county officials.
“My children were fortunate to grow up with fluoride in their water, and they’ve had very few dental issues,” Commissioner Richard Helms stated before the vote. On the other hand, Commissioner David Williams argued for ending the practice: “Let’s refrain from adding something to the water that’s meant to treat us and give people the freedom to choose.”
Barrett’s water, however, comes from the city of Monroe, not the Yadkin facility. Therefore, she will continue to consume water fortified with fluoride, at least for now. “I’m suspicious as to why they add that to our water,” she shared with KFF Health News.
A National Trend: The Fluoride Controversy Spreads
This situation is unfolding nationwide. From Oregon to Pennsylvania, hundreds of communities in recent years have either halted the addition of fluoride to their water supplies or voted against its inclusion. Advocates for these bans argue that people should have the freedom to decide. They highlight the availability of over-the-counter dental products containing fluoride, suggesting that adding it to public water sources may no longer be necessary. However, the Centers for Disease Control and Prevention (CDC) points out that while these store-bought products do reduce tooth decay, the most significant protection comes from using them along with water fluoridation.
The Cost of Fluoride Removal
An ongoing federal case in California could potentially compel the Environmental Protection Agency (EPA) to establish a rule regulating or prohibiting the use of fluoride in drinking water nationwide. In the meantime, this trend is raising concerns among public health researchers, who fear that similar to vaccines, fluoride may be facing challenges despite its success.
Public Health Perspectives
The CDC maintains that community water fluoridation is not only safe and effective but also results in significant cost savings in dental treatments. Public health officials emphasize that removing fluoride could be particularly harmful to low-income families, for whom drinking water may be their only source of preventive dental care.
If individuals have to seek care on their own, it changes the entire dynamic,” explained Myron Allukian Jr. a dentist and former president of the American Public Health Association. Millions have been drinking fluoridated water for years, he noted, without any major health issues arising. “It’s much easier to prevent a disease than to treat it.
Local Voices, Global Impact
According to the Fluoride Action Network, since 2010, over 240 communities worldwide have either eliminated fluoride from their drinking water or chosen not to add it.
Community Engagement and Division
A look at Union County demonstrates the intensity of these discussions. Typically, when commissioners gather at Monroe’s Government Center, there are often more empty seats than attendees. However, sessions discussing the prohibition of fluoride in public water supplies drew large crowds, with residents expressing divided opinions.
The Spectrum of Criticism
Critics of fluoride allege that the mineral is responsible for a range of ailments, from acne to high blood pressure, thyroid dysfunction, and even bone cancer. While the National Institutes of Health acknowledges that consuming excessive fluoride can lead to various symptoms such as nausea, vomiting, abdominal pain, and bone issues, the recommended dosage in drinking water has always been minimal. In 2015, the Department of Health and Human Services lowered the optimal fluoride concentration from 1.2 milligrams per liter to 0.7 mg/L.
Case Studies: Impact of Fluoride Removal
Juneau, Alaska, removed fluoride from its drinking water in 2007. A study published in BMC Oral Health in 2018 analyzed the dental records of children and adolescents before and after the city ceased fluoridation. The study found that cavity-related procedures and treatment costs increased significantly after fluoride removal. Portland, Oregon, remains the largest city in the nation to consistently reject water fluoridation. Voters have repeatedly turned down measures to introduce it, most recently in 2013. In Wichita, Kansas, despite strong recommendations from local healthcare professionals, voters have rejected fluoridation multiple times, the most recent being in 2012. The Brushy Creek Municipal Utility District in Williamson County, Texas, ended its fluoridation practice in December 2023 after adding fluoride in 2007. In 2016, Collier County, Florida, commissioners initially chose to retain fluoride in the water system but later unanimously reversed the decision following a 2023 Health Freedom Bill of Rights county ordinance, citing concerns about potential health effects. The State College Borough Water Authority in Pennsylvania ceased adding fluoride to the water for its 75,000 customers in March 2023. Officials cited potential environmental contamination, medical freedom concerns, and possible adverse health effects, such as faint white lines on teeth and lowered IQ for babies, as reasons for their decision.
Research and Controversies
A study published in JAMA Pediatrics in 2019 linked fluoride exposure during pregnancy to lower IQ scores in children across six Canadian cities. However, the study’s reliance on self-reporting and perceived methodological shortcomings have led to criticisms. In 2016, several advocacy groups, including the Fluoride Action Network and Food & Water Watch, petitioned the EPA to end water fluoridation under the Toxic Substances Control Act. They alleged significant research showing fluoride’s neurotoxicity at current doses. The same groups filed a federal lawsuit against the EPA the following year after their citizen petition was denied. During a 10-day bench trial in San Francisco, which concluded in mid-February, the two sides debated the risks and uncertainties surrounding water fluoridation. If Senior U.S. District Judge Edward Chen determines that water fluoridation poses an “unreasonable risk” to human health, the EPA will be compelled to establish a rule regulating or prohibiting water fluoridation nationwide. A decision is expected imminently.
Looking Ahead: Local Control and Future Directions
For now, the decisions regarding water fluoridation in community systems remain primarily at the local level—an aspect that Barrett hopes will change.
Of all things, they want our teeth healthy when basic needs like housing and food are lacking,” she laments.
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