Removing Fluoride from US Water Would Increase Millions of Cavities, Raise Costs by $9.8 Billion

A new modeling study published in JAMA Health Forum predicts that removing fluoride from public water systems in the US could lead to 25.4 million additional decayed teeth in children within five years, with related health care costs estimated at $9.8 billion. This impact would disproportionately affect children from low-income families or those covered by Medicaid, who benefit most from fluoridated water. Fluoride, added to public water since 1945, has been credited as one of the 20th century's greatest public health achievements by preventing tooth decay by strengthening enamel and inhibiting bacterial activity. The study, using data from the National Health and Nutrition Examination Survey, also estimates that the prevalence of dental caries would increase by 7.5 percentage points if fluoridation ends, with a projected rise in costs to $19.4 billion over ten years. Despite concerns about fluoride's neurotoxic effects at high doses, experts emphasize that current fluoridation levels are safe and effective, cautioning that removing fluoride could worsen dental health disparities and increase overall healthcare burdens. This research comes amid policy debates led by US Health and Human Services Secretary Robert F. Kennedy Jr., who has advocated ending water fluoridation and prompted reviews by the Environmental Protection Agency.