A New JAMA study projects nearly $10 billion in increased healthcare costs due to decreasing community water fluoridation in the U.S.
By Paige Anderson, CRDH
In May 2025, a new study published in JAMA Health Forum cast a bright spotlight on a pressing issue that continues to gain momentum across the United States: the rollback of community water fluoridation (CWF). As more municipalities reconsider or eliminate fluoride from their water supplies, dental and medical professionals are sounding the alarm.
The study projects significant increases in oral disease burden and healthcare costs, especially among children. For the dental community, these findings aren't surprising, and they aren’t just statistics. They represent a call to action.
Study Data
The study used nationally representative data collected in the U.S. National Health and Nutrition Examination Survey for 2013 to 2016. These surveys provided information about 8,484 children under 19, which the study then used to create projections of the impact on caries rates and healthcare costs due to decreasing community water fluoridation rates. Based on their data analysis, we can expect:
- A “best-case scenario” of a 7.5% increase in dental caries in the next five years if CWF rates continue to decrease at the current rate.
- A $9.8 billion increase in healthcare costs as a direct result of worsening oral health outcomes.
- Disproportionate effects for uninsured and publicly insured children and those living in rural and remote areas.
In addition to well-established literature on the potential harms to oral health, this study provides a financial context that may help to sway some community leaders away from ending fluoridation programs. However, there is still a steep and unfortunate uphill battle in changing public perception to improve fluoride acceptance.
Why De-Fluoridation?
The vast majority of dental professionals (including about 92% of surveyed dentists) support community water fluoridation, and with good reason. Water fluoridation has frequently been celebrated as one of the major public health accomplishments of the past century. So why are legislators suddenly ramping up campaigns to remove it?
1. Lack of Public Understanding and Misuse of Data
Doubts about water fluoridation have existed for as long as these programs have been around, and social media has allowed misinformation and misinterpretation of data to spread faster and more aggressively than ever.
For example, a recent meta-analysis that highlighted potential negative impacts of fluoride on children’s IQ made the rounds and amplified parents’ fears. However, experts such as Steven Levy of the ADA National Fluoridation Advisory Committee have identified deep methodological flaws in the analysis.
The report focused on countries with high levels of naturally occurring fluoride, more than double the level recommended in the U.S. A longitudinal study out of Queensland, Australia, shows that fluoride exposure at recommended levels has no link to reduced cognitive neurodevelopment.
2. Public Distrust of Government and Increased Focus on Personal Choice
More than half of the adults surveyed worldwide believe that public drinking water will harm them in the next two years. According to a study published in Nature Communications in 2024, this self-reported belief may be related to a high perception of corruption in the public sector.
Similarly, since the COVID pandemic, there has been a surge in the perception of personal choice as diametrically opposed to public health measures. These two beliefs are likely fueling increased resistance to CWF against the long-standing recommendations of health organizations, including the American Dental Association, American Academy of Pediatrics, U.S. Public Health Service, World Health Organization, and Centers for Disease Control and Prevention.
How Has This Played Out in Other Areas of the World?
While the JAMA study provides projections on what we can expect from decreased CWF in financial and health impacts, we can see how those real-world impacts will play out by looking at communities that lost access to CWF in recent years.
The city of Juneau, Alaska, discontinued water fluoridation in 2007. In 2018, a study showed a significant increase in caries and per-patient treatment costs. These effects had the greatest impact on children born after water fluoridation was stopped and had knock-on effects in terms of poorer school performance due to oral health problems (for those who are concerned about children’s IQ).
Calgary, Canada, will actually be reintroducing community water fluoridation as of June 30, 2025, because the oral health fallout of removing it was so severe. Pediatric dentists report not just more common caries but also more aggressive and severe cases. This has led to a 78% increase in the use of general anesthesia to treat decay in young children.
In short, communities without water fluoridation have seen an increase in serious health risks to children as a result.
What This Means for Your Dental Practice
Dentists are not powerless in the face of policy shifts. Here are five ways we can help mitigate the impact of fluoridation rollbacks:
- Educate patients and caregivers: Use every interaction as an opportunity to explain the role of fluoride in preventing cavities. Address myths directly and cite reputable sources like the ADA and the WHO.
- Monitor local policies: Stay informed about water fluoridation discussions in your city or county by attending town halls, writing op-eds, and connecting with public health officials.
- Enhance preventive care protocols: In non-fluoridated areas, increase the use of fluoride varnishes, offer dietary counseling, and consider recommending fluoride rinses or supplements.
- Support school and community programs: Partner with schools to deliver oral health education and expand access to sealants and cleanings. Advocate for mobile dental clinics in underserved communities.
- Use your platform: Dentists have a trusted voice, whether through social media, newsletters, or their practice website. Use it to share science-backed messages about fluoride and public health.
If you have the time and motivation, you can contact your representatives to voice your opposition to ending community water fluoridation in your area. As you’re likely aware, local dental associations are frequently active in local politics and may have resources to help correct the course.
The elimination of community water fluoridation is not a theoretical concern. It's happening now, with measurable consequences for pediatric oral health and the broader healthcare system. The recent JAMA study underscores the importance of fluoride as a public health measure and warns of the human and financial costs of inaction.
As frontline providers, we are uniquely positioned to counter misinformation, support evidence-based policies, and ensure that prevention remains at the heart of oral healthcare. By staying informed, engaged, and vocal, the dental profession can help safeguard the oral health of the next generation.
Want to learn more? Stay tuned for an invaluable Elite Learning Series presentation on September 9, 2025. Dr. Sharon Gordon, Associate Dean of Academic Affairs and Research at Kansas City University, will address fluoridation guidelines and how doctors should inform their patients.
Author: Paige Anderson is a certified registered dental hygienist with eight years of clinical experience and an English degree. She blends her two areas of expertise to create resources for dental providers so they can change lives by giving their patients the highest possible standard of care.
