The Fluoride Fallout: What Dentists Need to Know as States Shift Policy

By Genni Burkhart

In March 2025, Utah became the first state in the country to officially ban the addition of fluoride to its public water systems.¹ Just weeks later, Florida passed a similar measure, included in its broader farm bill, that prevents any “additives” from being introduced into municipal water supplies. Governor Ron DeSantis is expected to sign the bill into law, making Florida the second state to take action on this heavily debated issue.

Although not all bills explicitly name fluoride, their language effectively removes the mineral from public health programs that have been in place for nearly 80 years. Several other states, including Tennessee, Kentucky, and Nebraska, are considering similar proposals that could either ban fluoride outright or make it optional at the municipal level.²

The Origins of Fluoridation

Water fluoridation was introduced in Grand Rapids, Michigan, in 1945, following clinical research that found strong links between natural fluoride in drinking water and lower rates of dental caries. By 1960, more than 50 million Americans were receiving fluoridated water, and by 2018, that number had risen to nearly 211 million, or approximately 73% of those served by community water systems.³

Dental organizations and public health agencies have long cited fluoridation as one of the greatest public health achievements of the 20th century, attributing it to a 25% reduction in cavities in children and adults.³

Why the Debate Has Returned

Opposition to water fluoridation has existed since its inception, but a resurgence of scrutiny has grown in recent years. A 2024 review published in U.S. News & World Report suggested that water fluoridation may now offer less marginal benefit than in decades past, largely because fluoride is readily available through other means, such as toothpaste and professionally applied treatments.⁴

Meanwhile, growing concern about the potential neurodevelopmental and endocrine effects of early fluoride exposure⁵, especially in infants and during pregnancy, has drawn attention from advocacy groups and political figures. In April 2025, U.S. Health and Human Services Secretary Robert F. Kennedy Jr. announced his intention to push the CDC to revise its long-standing guidance on community water fluoridation.⁶

Some studies, including those cited in a Canadian-led review, have suggested a possible link between prenatal fluoride exposure and lower IQ scores in children. While not universally accepted, these findings have been used to justify increased public skepticism.⁷

Health Organizations Respond

The American Dental Association (ADA) continues to strongly support community water fluoridation as a safe, effective, and equitable public health measure. In a recent statement, the ADA warned that bans on water fluoridation could reverse decades of progress in reducing dental disease and could disproportionately affect underserved communities.⁷

In response to state-level policy changes, the ADA and other organizations have emphasized the importance of maintaining access to fluoride through clinical care and individual counseling. They have also published updated provider resources to help clinicians address patient questions, including how to identify local water fluoridation status and when to recommend fluoride supplements.

Other organizations that support public water fluoridation include:

• The American Water Works Association (AWWA).
• The World Health Organization (WHO).
• The American Academy of Pediatrics (AAP).
• The Centers for Disease Control (prior to the current administration) (CDC).

Practical Implications

For dental professionals, these shifting policy changes require more than simple awareness. The negative public perception and local, state, and federal policy changes require adjustments in patient communication and preventive care strategies. When a patient lives in a non-fluoridated community, providers may need to evaluate the individual caries risk profile and recommend fluoride varnishes, supplements, or prescription-strength toothpaste accordingly.

In addition, clinicians may need to revisit how they frame fluoride discussions. Many patients are arriving with heightened concerns shaped by social media, influencers, and even political discourse. Dental teams should be prepared to respond with facts, maintain a neutral tone, and emphasize the evidence that guides clinical recommendations.

Understanding local and state-level developments on this issue is now part of your obligation to stay informed. Whether through continuing education, ADA alerts, or professional networks, dentists and hygienists must keep track of which regions are making policy changes, how those changes affect patients, and make plans to approach discussions and actions with patients.

Specific Populations at Higher Risk

Removing fluoride from public water systems may disproportionately affect children in low-income and rural communities, where access to regular preventive care is more limited. Water fluoridation has historically helped close gaps in oral health outcomes across socioeconomic lines, making its rollback concerning for dental and public health professionals.⁷

These developments also place more responsibility on dental providers to fill in the prevention gap. That includes community outreach, preventive education, and advocacy for localized fluoride access when possible.

What Comes Next?

As of May 2025, Utah's fluoride ban is in effect, and Florida’s law awaits the governor’s approval. Tennessee, Kentucky, Nebraska, and South Dakota have similar bills moving through their legislatures. While not every proposal is guaranteed to succeed, the momentum to move away from public water fluoridization is clear. However, the debate over water fluoridation is far from settled.

For dental professionals, the path forward is rooted in evidence-based care, personalized recommendations, and patient trust. Fluoride remains a powerful tool in the fight against tooth decay. But as the policy environment changes, so must the strategies used to protect oral health at every level.

References

1. Dunphey, Kyle (2025, May 5). As Utah’s fluoride ban begins, health officials urge Utahns to protect their teeth. Utah News Dispatch. Retrieved here.
2. Nirappil, Fenit (2025, April 30). Florida lawmakers pass ban on fluoride in drinking water. The Washington Post. Retrieved here.
3. Centers for Disease Control and Prevention. (2024). Community Water Fluoridation Facts. Retrieved here.
4. Foster, Robin. (2024, October 4). Water fluoridation may be less beneficial than in the past, review finds. U.S. News & World Report. Retrieved here.
5. Associated Press  (2025, April 7). Kennedy says he plans to tell CDC to stop recommending fluoride in drinking water. Politico. Retrieved here.
6. Anderson, Olivia. (2025, April 9). RFK Jr. to tell CDC to change fluoride guidelines. ADA News. Retrieved here.
7. Portalatin, Ariana. (2025, April 9). Dental groups stand firm on fluoride as federal threats loom: 'Our nation is at risk.' Becker’s Dental Review. Retrieved here.

Author: With over 15 years as an award-winning journalist, editor, and writer, Genni Burkhart has covered everything from news, politics, and healthcare to finance, corporate leadership, and technology. As editor-in-chief of The Incisor newsletter and blog and features writer at DOCS Education, she brings a refreshing insight and a passion for storytelling to the world of sedation dentistry.