The Problem with Public Water Fluoridation and the Changing Tide 

To better understand how fluoride ended up in our drinking water and why fluoridated water poses more health risks to our most vulnerable, such as infants, young children, pregnant women, and those with certain medical conditions, it is important to understand the history of water fluoridation in the United States.

The History of Fluoridated Public Drinking Water and Dental Health

In 1901 a young dental school graduate, Frederick McKay, began practicing in Colorado Springs, Colorado and made an unsettling discovery when examining many residents’ teeth. Their teeth were stained dark brown. McKay, intrigued with what was then known as Colorado Brown Stain and later called dental fluorosis, could find no explanation from his dental studies for this tooth anomaly. With the help of a dental researcher, Dr. G.V. Black, the two discovered that this peculiar, mottled enamel was prevalent in young children, but most unexpectedly, these brown-stained teeth were resistant to decay. McKay believed that something in the water might be the culprit for dental fluorosis.

Years of dental fluorosis research commenced, with chemists studying drinking water samples in various towns around the US where brown-stained teeth occurred. Their research resulted in the game-changing discovery: high levels of naturally occurring fluoride, a mineral that occurs in the Earth’s rocks and soil and naturally leaches into water supplies, caused the brown discolored tooth enamel but were also linked to reduced tooth decay. By the 1930s, a more accurate way to measure fluoride levels in water revealed fluoride levels of up to 1.0 parts per million (ppm) in drinking water did not cause enamel fluorosis for the majority of people and only mild enamel fluorosis in a small percentage of others.

Using this evidence-based science, Grand Rapids, Michigan in 1945 became the first community to add fluoride to its public drinking water for the purpose of reducing dental cavities. For 15 years after, researchers tracked the rate of tooth decay among nearly 30,000 school-aged children in Grand Rapids. Their findings: For children born after fluoride was added to tap water, the dental cavity rate in this group dropped more than 60 percent. Science had dramatically shaped preventive dental care for the general public, and local municipalities across America implemented water fluoridation systems.

The Health Risks of Fluoridated Public Drinking Water and Changing Public Opinion

Since the 1940s, it has become commonplace for fluoride compounds to be added to our drinking water in the US, which is decided and voted upon at a county level. There has, however, been a push back to this trend in recent years due to the health effects of too much systemic fluoride. Some known health risks of excessive systemic exposure to fluoride include:

• Lower IQs in children who have been exposed during fetal development and in early childhood, raising concern about safe fluoride levels and early brain and cognitive development.
• Weakened muscle tissue, joints, and skeletal structures (i.e., skeletal fluorosis)
• Endocrine and hormone disorders such as a thyroid gland dysfunction
• Damaged tooth enamel with discoloration and pitting, otherwise known as dental fluorosis
• Skin problems such as acne, cardiovascular problems, reproductive issues, and neurological problems such as ADHD, are other known health issues linked with excessive systemic exposure to fluoride.

Fluoride often occurs in natural water sources, like spring water for example, but at a very low concentration and in the natural and safer form of calcium fluoride. Conversely, the type of fluoride that is added to the municipal water supply is a much higher dosage (historically 5–10 times the amount) and is the least natural and more toxic forms of fluorosilicic acid, sodium fluorosilicate, or sodium fluoride, with fluorosilicic acid the most common form due to its low cost and availability. Natural calcium fluoride is considered the “least toxic” because of its high insolubility. Both calcium and magnesium are known minerals that counteract the effects of fluoride, an example of how nature often pairs antidotes with poisons and designs “complete” foods and nutrients that often mitigate harmful substances.

In the United States, prior to 2015, the U.S. Public Health Service (PHS) recommended a range of 0.7 to 1.2 mg/L, depending on a location’s climate. However, in 2015 the PHS updated the recommendation to a lower uniform value of 0.7 mg/L for all areas. Bottled water derived from natural sources (springs, rivers, or lake water) has a much lower concentration of naturally occurring calcium fluoride. In 2005 the USDA conducted a study and concluded that bottled water derived from natural water sources had an average of 0.11 mg/L. This is roughly 6 times lower than the 0.7 mg/L current guidelines in our municipal water supply.

Now that fluoride is readily available in topical dental products like toothpaste, dental floss, and mouthwash, the health impact and cost analysis of public water fluoridation need to be revisited. Since 2010, more than 240 communities in the world have rejected the use of fluoridated water, of which more than 170 are in the US. Some of these communities, like Weston, Georgia, have as few as 80 residents. Others are larger, however, like Portland, Oregon, and have roughly 900,000 residents. Hawaii is the only state that has entirely banned the fluoridation of water. Most Western European countries including Italy, France, Germany, Netherlands, Austria, Poland, Hungary, Switzerland, and most of the UK do not fluoridate their water supply.

In 2015 the Cochrane Collaboration, a global team of renowned healthcare experts and researchers, provided the Cochrane report—a compilation of water fluoride studies—to review the initial water fluoridation findings and the risks and benefits of water fluoridation, especially at current levels in our tap water combined with other fluoride-containing products. They studied countries abroad with and without fluoridated water and found countries that didn’t fluoridate their water supply still had reduced rates of dental cavities, raising the on-going question of whether current fluoride dosing in our tap water is necessary and acceptable when there are other available means of dental decay prevention.

In September of 2024, a US court ruling declared the current recommended water level of fluoridation (0.7 mg per L) poses an unreasonable health risk, and as such, the US Environmental Protection Agency must address the call for safer fluoride standards for the public.

Wiseman Health Take-Home Advice

• To prevent dental caries (cavities), the most effective lifestyle strategy is to consume a whole foods diet low in sugar and processed foods, along with practicing good dental hygiene.
• Not all fluoride is “created equal”. There is a safety difference in the form and the concentration of naturally occurring calcium fluoride in natural water sources versus the higher concentration and industrial forms of fluorosilicic acid, sodium fluorosilicate, and sodium fluoride that are added to our municipal water supply.
• The best and safest way to use fluoride for dental health is through topical treatment. This means regular teeth brushing with fluoridated toothpaste that is not swallowed but spit out and rinsed out after use. By using an isolated, topical strategy such as this, you benefit from a localized treatment on your teeth but with less systemic risks than you would get from swallowing fluoridated water.
• If you are at low risk for dental caries, sensitive to fluoride, practice good dental hygiene, and do not consume a lot of sugar and processed food, there are fluoride-free toothpaste options rather than fluoridated toothpaste.
• Visit the Centers for Disease Control and Prevention to find out whether your US county and municipality fluoridates its water supply.
• Many counties in America are opting out of public water fluoridation in their communities. Visit the Centers for Disease Control and Prevention to find out whether your US county and municipality fluoridates its water supply.
• If you live in a local community that fluoridates its public water supply, it is best practice to avoid consuming this water for drinking; instead, implement an at-home strategy to purify your home tap water for drinking through a reverse osmosis system or consume purified bottled water or bottled spring water that you can purchase at your local health food store or grocery store. All other uses of tap water at home, such as for washing clothes and bathing, are perfectly safe.
• A cost-effective way of purifying your water and fluoride at home can be accomplished with a countertop reverse osmosis filter such as AquaTru reverse osmosis water purifiers. You can also invest in a home reverse osmosis system installed directly into your house by a local water purifying company in your area.
• Read our Wiseman Health article The Importance of Drinking Pure Water for other cost-effective ways to purify your home water and to consume cleaner drinking water.
• Learn how other countries approach the public water fluoridation issue here
• Watch our video from 2014: Wiseman Family Practice Speaks Out Against Water Fluoridation at Austin City Council

Editor’s Note: This content was created by our Wiseman Health content and writing team, without the influence of artificial intelligence engines. Our goal is to be your trusted source for natural health and medical information.