by Guy Page

In response to anti-flouride initiatives in some states and at the federal level, the State of Vermont Health Department says community water fluoridation is both safe and beneficial.

Whether or not to add fluoride to community water systems has been a low-key but ongoing policy debate since the practice began in earnest in 1945, after several studies in the 1930’s reported a low prevalence of dental caries among people consuming natural drinking-water with high fluoride.

Water fluoridation, in which controlled amount of fluoride is added to the public water supply, was considered one of the greatest successes in public health in the twentieth century, and one of the most popular methods of delivering fluoride systemically to a large population with no need for its active participation, the National Institute of Health states. It is practiced in many countries throughout the world.

In 1945, public water fluoridation was implemented for the first time in the US, and was recommended by the World Health Organization (WHO) as the main delivery method of fluoride to improve oral health. By 2012, more than 435 million people worldwide had access to either naturally fluoridated water (about 57 million) or water with adjusted fluoride concentrations at or near optimal level (about 378 million). Some of these countries include the US, Brazil, Australia, Canada, Spain, Argentina, South Korea, and New Zealand.

The Flouride Debate leapt to the front pages after the election of President Donald Trump and his successful nomination of Secretary of Health and Human Services of Robert F. Kennedy Jr., a noted fluoride skeptic. As predicted, Kennedy issued an anti-flouride advisory in January.

“On January 20, the Trump White House will advise all U.S​. water systems to remove fluoride from public water,” Kennedy said in a post on X. “Fluoride is an industrial waste associated with arthritis, bone fractures, bone cancer, IQ loss, neurodevelopmental disorders, and thyroid disease.” Kennedy has been outspoken in his belief that the ‘autism epidemic’ is caused by environmental toxins – although he has not specifically cited fluoride as such.

Also, Florida’s surgeon general issued a guidance on Nov. 22 about a possible neuropsychiatric risk associated with fluoride exposure. Tennessee is considering related legislative action.

“Due to the neuropsychiatric risk associated with fluoride exposure, particularly in pregnant women and children, and the wide availability of alternative sources of fluoride for dental health, the state surgeon general recommends against community water fluoridation,” Florida Surgeon General Dr. Joseph A. Ladapo said.

In his November statement, Ladapo notes that many municipalities across the U.S. and several European countries, including Austria, Belgium, France, Germany, Italy, Norway, and Sweden, have eliminated water fluoridation.   

“Today, fluoride is widely available from multiple sources, including topical fluorides, such as toothpaste, mouthwashes, and fluoride applications by dental providers. Evidence shows fluoride strengthens teeth, making them more decay resistant. However, additional research is being conducted to review the impacts of overall fluoride exposure in the population,” Ladapo said.

He urged awareness of safety concerns related to systemic fluoride exposure including:  

• Adverse effects in children reducing IQ, cognitive impairment, and attention deficit hyperactivity disorder. 
• Increased neurobehavioral problems in children whose mothers ingested fluoride during pregnancy. 
• Accumulation of fluoride in the pineal gland, causing sleep cycle disturbance.  
• Skeletal fluorosis, which could increase the risk of bone fracture. 
• Potential risk of premature menarche in adolescent girls. 
• Potential suppression of the thyroid gland by inhibiting iodine absorption. 

Vermont Health Department disagrees on risk, stresses dental health value

Written with the assistance of Oral Health Director Dr. Robin Miller, an article in the May VDH newsletter states that flouride at the right levels is beneficial to oral health and poses no other dangers. Published verbatim below:

Community water fluoridation has been around for 80 years and is considered one of the top ten public health successes. Even with widespread use of fluoride toothpaste and other tooth decay prevention efforts, studies continue to show that water fluoridation reduces dental decay by at least 25% in children and adults. Community water fluoridation ensures everyone in the community — regardless of their age, income, or ability to get dental care — has an equal chance of getting enough fluoride to prevent cavities.   

In Vermont, about 57% of people on public water systems get water with added fluoride (40 water systems). Water operators monitor fluoride levels daily. The Health Department supports these community programs by providing testing supplies, equipment and tracking monthly fluoride levels. We also manage an internal private well fluoridation tracking system and work to promote water testing as a whole.  

Here are the facts, VDH states: 

• Fluoride is a mineral found naturally in the air, water, soil, plants, and many foods. It supports strong and healthy teeth by strengthening enamel, which can stop cavities. 

• You need the right amount of fluoride to get the benefits. Not enough fluoride won’t protect against tooth decay, while very high fluoride levels can be dangerous. In the U.S. and Vermont, water operators monitor fluoride levels daily to make sure just enough fluoride is added to reach the ideal level of 0.7 milligrams per liter (mg/L)—which is less than half of the World Health Organization’s advised safe limit of 1.5 mg/L.  

• Tooth decay increased when communities stopped water fluoridation programs. In the Canadian city of Calgary, cavities increased significantly in elementary school children five years after the city council banned water fluoridation in 2011. They ended up voting to put fluoride back in the water in 2021. After Juneau, Alaska, banned water fluoridation, children under six were found on average to need almost one additional cavity procedure per year.  

• Poor dental health has a big impact. Cavities are painful, make it hard to eat certain foods and can be expensive to treat. Tooth decay and tooth loss can also be stigmatizing and negatively affect mental health, self-esteem, and even job opportunities. Dental disease can also increase a person’s risk for uncontrolled diabetes, heart disease, stroke and more. 

The Dept. of Health newsletter summarizes: “Community water fluoridation gives everyone an equal chance to get enough fluoride to prevent cavities—no matter their age, income, or access to dental care. It’s proven that when communities stop adding fluoride to their water, cavities go up. That’s why in Vermont, the Health Department supports water systems in keeping fluoride at safe levels and encourages communities to continue fluoridating their water. It’s a simple, effective way to protect healthy teeth and benefit overall well-being.”