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By Jenna deJong
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Utah has banned the addition of fluoride to public drinking water, becoming the first U.S. state to do so. The law, signed by Republican Governor Spencer Cox on March 27, will take effect on May 7.
The move follows calls by Health and Human Services Secretary Robert F. Kennedy Jr. to eliminate fluoride from the United States' water systems, citing concerns about health risks despite long-standing scientific consensus on its safety and benefits.
Why It Matters
Water fluoridation is a public health intervention credited with reducing cavities and improving dental health for decades. While opposition to fluoridation is not new, it has gained traction in recent years with the rise of skepticism toward government health mandates and a renewed focus on possible side effects.
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In November, Kennedy posted on X, formerly Twitter, that "fluoride is an industrial waste associated with arthritis, bone fractures, bone cancer, IQ loss, neurodevelopmental disorders, and thyroid disease."
What To Know About Fluoride
Fluoridation of community water systems began in the U.S. in 1945 and is considered one of the country's major public health successes. The Centers for Disease Control and Prevention has called it "a cornerstone strategy for prevention of cavities" and named it one of the 10 greatest public health achievements of the 20th century.
The CDC says on its website that water fluoridation is "a practical, cost-effective, and equitable way for communities to improve their residents' oral health regardless of age, education, or income." Fluoridated water reduces cavities by about 25 percent in both children and adults and yields cost savings for communities—$32 per person annually in avoided dental treatment.
Fluoride is a naturally occurring mineral found in soil, water, and rocks. Its cavity-preventing benefits were discovered in the early 20th century when researchers noticed lower dental decay rates in communities with higher natural fluoride levels. In 1945, Grand Rapids, Michigan, became the first city to fluoridate its water supply, resulting in a 60 percent reduction in tooth decay among 30,000 schoolchildren over 15 years, Reuters reported*.*
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What to Know About Utah's Ban on Fluoride in Drinking Water
The new Utah law prohibits any city or public water authority from adding fluoride to drinking water, overriding existing local policies. As of 2022, about 44 percent of Utah residents received fluoridated water, one of the lowest rates in the country, according to the CDC.
Governor Cox said the mixed application across the state had shown no significant variation in dental outcomes.
"You would think you would see drastically different outcomes with half the state not getting it and half the state getting it. I've talked to a lot of dentists. We haven't seen that," Cox told ABC4 Utah earlier this month. "So it's got to be a really high bar for me if we're going to require people to be medicated by their government."
The law does not cite health concerns but reflects Cox's belief that fluoridation should not be a government-imposed standard.
Why Is Fluoride Found in Drinking Water?
The practice of water fluoridation began after researchers determined that communities with natural fluoride in their water had lower rates of dental decay. Fluoride strengthens tooth enamel and can reverse early signs of tooth decay. Public health officials identified 0.7 parts per million as the optimal level to reduce cavities without causing unwanted effects like mild tooth discoloration.
Community water fluoridation became a passive but effective means of improving dental health, particularly in populations with limited access to dental care. Johns Hopkins University says, "By adding it to the water supply, it's available to everyone, regardless of their access to dental care or their ability to routinely participate in home oral hygiene practices."
Leading health organizations such as the American Dental Association, the American Academy of Pediatrics, and the CDC endorse the addition of fluoride to public water supplies, citing its effectiveness in reducing tooth decay.
Why RFK Jr. Wants Fluoride Out of Drinking Water
Kennedy has long been a critic of fluoridation, raising concerns about its potential links to neurodevelopmental issues and other conditions. He has argued, without evidence, that fluoride has been linked to numerous health issues, including cancer.
He said removing fluoride should be part of a broader rollback of public health mandates, a position that has drawn criticism from public health experts. Research reviewed by the National Institutes of Health found some association between high fluoride exposure and lower IQ in children. However, those levels were significantly higher than those used in U.S. municipal water.
The American Cancer Society states that most research has not found a strong link between fluoridated water and cancer. A 1990 study found uncertain evidence of increased osteosarcoma in male rats, but later human studies failed to confirm this.
Reviews by the U.S. Public Health Service and National Research Council concluded that available data do not support an association between fluoride and cancer. As the ACS notes, "the general consensus among the reviews done to date is that there is no strong evidence of a link between water fluoridation and cancer" and that further studies are needed.
Is Fluoride Found in Water Bad for You?
The consensus among public health experts is that fluoride is not harmful at levels used in U.S. municipal systems. The CDC reports that fluoridated water's only well-documented side effects at recommended levels are cosmetic, such as faint white marks on teeth in some children. Higher fluoride exposure, above federally allowed limits, may pose risks such as bone fractures or thyroid effects, but those levels are not used in community fluoridation programs.
What People Are Saying
Mark Fullner, a dentist in Utah County, told ABC4: "It really only hurts the children whose families are not aware of the benefits of the program, or cannot afford to go to their dentist or physician to get fluoride supplements. It also puts the burden of compliance on adults in those families who care enough to follow the guidelines to administer proper doses. Chances of a mistake in those circumstances seems to be much higher than the associated risks with well-monitored addition of fluoride to the water source."
What Happens Next
The CDC and public health experts continue to endorse community water fluoridation. Nevertheless, momentum may be shifting. Anti-fluoride legislation has been introduced in multiple states, including North Dakota, Montana, and Tennessee, and a federal judge in California recently ordered the Environmental Protection Agency to reassess its fluoride regulations due to emerging concerns about neurodevelopmental impacts.
As Utah's law takes effect in May, public health agencies and medical associations are expected to monitor dental health outcomes closely, particularly among children and low-income populations.
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