Waterdrop Explores the Controversy Around Fluoride and Drinking Water Safety

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For about 50 years, adding cavity-preventing fluoride to drinking water was a popular public health measure in Yorktown, a leafy town north of New York City.

But in September, the town's supervisor used his emergency powers to stop the practice.

The reason? A recent federal judge's decision that ordered U.S. regulators to consider the risk that fluoride in water [https://www.waterdropfilter.com/blogs/water-contaminants/is-fluoride-bad-for-you] could cause lower IQ in kids.

"It's too dangerous to look at and just say 'Ah, screw it. We'll keep going on,'" said the town supervisor, Ed Lachterman.

Yorktown isn't alone. The decision to add fluoride to drinking water rests with state and local officials, and fights are cropping up nationwide.

Water fluoridation is the addition of fluoride to a public water supply to reduce tooth decay. Fluoridated water contains fluoride at a level that is effective for preventing cavities; this can occur naturally or by adding fluoride. Fluoridated water operates on tooth surfaces: in the mouth, it creates low levels of fluoride in saliva, which reduces the rate at which tooth enamel demineralizes and increases the rate at which it remineralizes in the early stages of cavities. Defluoridation is needed when the naturally occurring fluoride level exceeds recommended limits. In 2011, the World Health Organization suggested a level of fluoride from 0.5 to 1.5 mg/L (milligrams per litre), depending on climate, local environment, and other sources of fluoride. In the United States, the HHS's guideline has been set at 0.7 mg/L since 2011. Bottled water typically has unknown fluoride levels

Tooth decay remains a major public health concern in most industrialized countries, affecting 60-90% of schoolchildren and the vast majority of adults. Water fluoridation reduces cavities in children, while efficacy in adults is less clear. A Cochrane review estimates a reduction in cavities when water fluoridation was used by children who had no access to other sources of fluoride to be 35% in baby teeth and 26% in permanent teeth. Most European countries have experienced substantial declines in tooth decay, though milk and salt fluoridation is widespread in lieu of water fluoridation. Some studies suggest that water fluoridation, particularly in industrialized nations, may be unnecessary because topical fluorides (such as in toothpaste) are widely used, and caries rates have become low.

Although fluoridation can cause dental fluorosis, which can alter the appearance of developing teeth or enamel fluorosis. the differences are mild and usually not an aesthetic or public health concern.Fluoride's effects depend on the total daily intake of fluoride from all sources. Drinking water is typically the largest source; other methods of fluoride therapy include fluoridation of toothpaste, salt, and milk. The views on the most efficient method for community prevention of tooth decay are mixed. The Australian government states that water fluoridation is the most effective way to achieve fluoride exposure that is community-wide. The World Health Organization reports that water fluoridation, when feasible and culturally acceptable, has substantial advantages, especially for subgroups at high risk while the European Commission finds that while water fluoridation likely reduces caries, there is no evidence that it is more effective than topical application

There is an ongoing debate whether fluoride exposure is correlated with lower IQ in children.

Public water fluoridation was first practiced in the U.S As of 2012, 25 countries practiced artificial water fluoridation, with 11 covering over 50% of their population. About 435 million people globally (5.4% of the population), including 211 million in the US (75% of the population), received fluoridated water at recommended levels. Additionally, 28 countries had naturally fluoridated water, often exceeding optimal levels.

By the end of 2022, fluoridation covered 72% of the US population (209 million people), while Europe largely abstained, except for Ireland and parts of Spain. In the UK, 10% of the population had fluoridated water, primarily in the Midlands and North East. Natural fluoride levels remained variable, with concentrations reaching up to 5.8 mg/L in Ireland and 30.2 mg/L in parts of Italy. These trends reflect shifts toward alternative fluoride methods and stricter regulatory oversight.

Major health organizations such as the World Health Organization and FDI World Dental Federation support water fluoridation as safe and effective at recommended levels. The Centers for Disease Control and Prevention lists water fluoridation as one of the ten great public health achievements of the 20th century in the U.S Despite this, some countries and communities have discontinued fluoridation, while others have expanded it Opponents of the practice argue that neither the benefits nor the risks have been studied adequately, and debate the conflict between what might be considered mass medication and individual liberties.

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