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A new modeling study published in JAMA Health Forum projects that eliminating fluoride from public water systems in the United States could dramatically increase dental health problems and healthcare costs among children and adolescents over the next five years.
Researchers from the Harvard School of Dental Medicine and Brigham and Women’s Hospital analyzed data from over 8,400 participants aged 0-19 years, using information from the National Health and Nutrition Examination Survey (2013–2016) and peer-reviewed studies on water fluoridation’s effectiveness1. The model compared a scenario where all US water systems stopped adding fluoride with one where current fluoridation levels were maintained.
Key Findings:
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The prevalence of dental caries (tooth decay) among children would rise by 7.5 percentage points (95% uncertainty interval: 6.3–8.5).
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An estimated 25.4 million additional decayed teeth would occur over five years (95% UI: 23.3–27.6 million).
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Healthcare costs related to dental caries would increase by $9.8 billion (95% UI: $8.7–10.8 billion) over five years, mainly due to increased risk of tooth decay and related complications.
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Cases of dental fluorosis (mild tooth discoloration from excessive fluoride) would decrease by 200,000, but this reduction is considered minor compared to the projected rise in cavities.
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Children who are publicly insured or uninsured would be disproportionately affected, worsening existing health disparities.
The study comes amid renewed debate over water fluoridation, a practice credited with reducing dental decay since its introduction in the 1940s. Some US states, such as Utah and Florida, have already passed legislation to remove fluoride from tap water, while cities like Calgary, Canada, have reversed earlier decisions to end fluoridation after seeing a spike in childhood cavities.
The authors note that, despite concerns about potential toxic effects at high fluoride levels, the evidence supports substantial ongoing benefits of water fluoridation at the safe levels currently recommended by US health authorities. However, the study did not model potential cognitive harms from fluoride exposure, citing a lack of strong direct evidence at current public water levels. It also did not account for indirect costs such as missed school or work due to dental problems, and focused only on children and adolescents.
Expert Perspective
Water fluoridation is widely recognized as a key public health measure for reducing dental caries, particularly in communities with limited access to dental care. The Centers for Disease Control and Prevention (CDC) estimates that providing optimally fluoridated water saves billions in dental treatment costs annually and reduces cavities by about 25% across communities.
Disclaimer
This article summarizes findings from a modeling study and related expert commentary. The projections are based on statistical models and assumptions, and actual outcomes may vary. The study did not assess all potential health effects of fluoride or include adult populations. For personal health decisions, consult with dental or medical professionals.
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