Fluoride Bans and Rising Cavity Rates: A Looming Public Health Concern

Tooth decay remains a significant public health issue, particularly among children. A new analysis indicates that bans on community water fluoridation could lead to a substantial increase in cavities and associated Medicaid costs. The analysis, conducted by the CareQuest Institute for Oral Health, projects a potential rise of over $40 million in Medicaid expenses within three years if five states – Florida, Kentucky, Louisiana, Missouri, and Oklahoma – eliminate fluoride from their water systems.

The Projected Impact of Fluoride Bans

The CareQuest Institute for Oral Health estimates that approximately 132,572 additional children would require treatment for cavities or tooth extractions over the next three years if these states proceed with fluoridation bans. Florida, having already implemented a ban on community water fluoridation last year, is projected to see 52,131 more children needing dental care than anticipated.

“Water fluoridation is the most broad-based, evidence-based, available-to-everyone tool that children can benefit from,” stated Melissa Burroughs, CareQuest’s senior director of public policy. “If you take that away, the impact on kids is significant.”

The CDC and the Benefits of Water Fluoridation

The Centers for Disease Control and Prevention (CDC) recognizes community water fluoridation as one of the most impactful public health achievements of the past century. Supplementing water systems with fluoride has been shown to reduce tooth decay in the United States by 25%. However, like vaccinations, fluoride has faced increasing scrutiny in recent years.

Growing Opposition and Legislative Efforts

According to the bipartisan National Conference of State Legislatures, at least 21 states have introduced legislation to ban or restrict the addition of fluoride to community water systems. Utah and Florida have already enacted outright bans, with those laws taking effect last year.

The Science Behind Fluoride’s Effectiveness

Dr. Scott Tomar, head of the department of population oral health at the University of Illinois in Chicago, explains the mechanism behind fluoride’s protective effect. “Fluoride is incorporated into the enamel, and it makes that tooth structure more resistant to acid attack, essentially making it less likely to be affected by the bacteria that causes tooth decay.” He notes that the consequences of fluoride bans will likely become apparent in the coming years, particularly among infants and toddlers as their enamel develops.

Potential for Increased Dental Health Costs

The CareQuest study estimates that Medicaid costs could reach nearly $40 million within three years if the five states enact water fluoridation bans. While approximately half of U.S. Children (37 million) are eligible for Medicaid, nearly half of those children do not currently receive dental care. Dr. Tomar suggests that the actual costs could be significantly higher, as many families rely on urgent care centers or hospital emergency departments for dental care – the most expensive and least effective care settings.

Federal Perspectives and Ongoing Debate

Health and Human Services Secretary Robert F. Kennedy Jr. Has previously characterized fluoride as “industrial waste.” However, acting CDC director Dr. Jay Bhattacharya emphasized the importance of fluoride for oral health, stating, “Fluoride is essential for oral health…The key thing is making sure the right dose is delivered in the right way.” He also acknowledged that excessive fluoride intake “can have neurological and developmental impacts,” though he did not provide specific details.

A 2025 analysis from the National Institute of Environmental Health Studies at the NIH found an association between higher fluoride levels and lower children’s IQ scores, but researchers did not recommend removing fluoride from drinking water. Dental experts generally dismiss studies linking fluoride to cognitive issues, citing that they were conducted in countries with significantly higher fluoride levels in water than those found in the U.S.

The CDC maintains that the optimal level of fluoride in drinking water is 0.7 milligrams per liter.