Artificial water fluoridation has been a common public health practice in the United States since the mid-20th century. First trialled by American scientists in 1945, fluoridation is credited with reducing tooth decay and improving dental health for millions of Americans. However, the topic remains one of debate, with discussions surrounding its necessity, effectiveness, ethics, and potential health implications growing in prominence.
With the confirmation of new US health secretary Robert F Kennedy Jr, a long-time advocate for ending the practice of fluoridation, America’s long history of fluoride treatment may be coming to a close. To help decode and contextualise this decision, we took a deep dive into the history, controversy, and current state of fluoridation in the United States of America.
The History of Water Fluoridation in the United States
Fluoride was first introduced into public water supplies as part of a pilot program to study its impact on dental health in Grand Rapids, Michigan, in 1945. American dentist Frederick McKay had noticed both discolouration and noticeably lower rates of decay in the teeth of Colorado Springs residents, and his testing suggested that both phenomena may be connected to their water supply.
After identifying the cause as elevated fluoride levels in his town’s water, McKay began experimenting with deliberate fluoridation in areas with lower natural levels. The results showed a significant decline in cavities, leading to widespread adoption across the country. Today, the Centers for Disease Control and Prevention (CDC) estimates that around 73% of Americans receive fluoridated water through their public supply.
Why Is Fluoride Added to Drinking Water?
The primary reason for adding fluoride to water is to reduce tooth decay and strengthen enamel. Fluoride helps remineralise tooth surfaces, making them more resistant to acids, bacteria, and cavities. According to the American Dental Association (ADA), fluoridation has been shown to reduce cavities by approximately 25% in both children and adults.
Public health authorities such as the CDC, the World Health Organization (WHO), and the American Medical Association (AMA) support fluoridation as a cost-effective way to improve oral health across populations, particularly for communities that may have limited access to dental care.
Fluoridation Levels and Regulations in the US
Fluoride levels in US drinking water are regulated by the Environmental Protection Agency (EPA) and the Department of Health and Human Services (HHS). In 2015, the recommended level for fluoridation was updated to 0.7 mg/L, replacing the previous range of 0.7 to 1.2 mg/L. This adjustment aimed to maintain cavity prevention benefits while reducing the risk of dental fluorosis (mild discolouration of the teeth caused by excessive fluoride exposure).
Fluoridation in the US: Where Is It Used?
Fluoridation is widespread across the US, but not all states or communities participate. Some states, such as Kentucky and Illinois, have high fluoridation coverage, while others, like Oregon and New Jersey, have lower rates due to higher natural levels or policy decisions. Certain cities and municipalities have also opted out of fluoridation through local policy decisions or public referendums.
Common Arguments For and Against Fluoridation
Arguments in Favour of Fluoridation:
- Proven Effectiveness: Studies consistently show that fluoridation helps prevent cavities and improves oral health at a population level.
- Cost-Effective Public Health Measure: The CDC estimates that for every $1 spent on water fluoridation, approximately $32 is saved in dental treatment costs.
- Universal Benefit: Unlike individual fluoride treatments or toothpaste, fluoridation benefits everyone with access to public water supplies, regardless of socioeconomic status.
Arguments Against Fluoridation:
- Personal Choice: Some argue that fluoridation takes away an individual’s right to choose what goes into their drinking water, likening it to mass-medication.
- Health Concerns: While major health organisations endorse fluoridation as safe, some opponents question its long-term health effects and potential links to neurological conditions.
- Redundancy: Some believe that adding fluoride to water is unnecessary given the developments in dental technology and improved availability of fluoride toothpaste since the practice first began.
How the US Compares to Other Countries
While fluoridation remains common in the US, many other developed nations do not fluoridate their water. For example:
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- Australia fluoridates around 90% of its drinking water, with strong government support.
- Canada has fluoridation in many regions, though some cities have discontinued the practice.
- Most of Western Europe does not fluoridate water, instead opting for alternative methods such as fluoridated salt or dental products.
- China actively removes fluoride from its drinking water, with several catchments and sources having natural fluoride levels much higher than the recommended range.
Can Fluoride Be Removed from Drinking Water?
Fluoride is one of the more difficult substances to remove from your water, passing straight through conventional carbon filters. A typical filter jug or fridge water dispenser will have little impact on fluoride levels.
However, for those who prefer to limit their fluoride intake, there are still effective filtration methods available:
- Reverse Osmosis: An extremely thorough water purification method that strips away the vast majority of impurities, including more than 90% of fluoride.
- Activated Alumina Filters: A specialised filtration medium that can reduce fluoride levels but requires regular maintenance and specific water conditions to operate at full capacity.
- Distillation: A process that removes nearly all impurities, including fluoride, but is less practical for large-scale or on-demand water use.
Conclusion
Water fluoridation in the US has been a significant public health initiative for over 75 years, helping to reduce cavities and improve dental health. While widely endorsed by health authorities, the practice remains a topic of debate. As of early 2025, the current US administration seems likely to halt fluoridation across the country, but a future cabinet can just as easily reinstate the practice.
Regardless of personal stance, those who wish to remove fluoride from their drinking water have several effective filtration options available. For Australians interested in managing their home water quality, Complete Home Filtration offers advanced filtration solutions designed to provide peace of mind and control over what’s in your drinking water. Contact us today to learn more about our water filtration systems.
