Inside The Growing Movement To Remove Fluoride From Drinking Water

A decades-old public health measure is facing renewed scrutiny as community groups across the United States mobilize to remove fluoride from municipal water supplies, challenging what has long been considered one of the most successful public health interventions of the 20th century. Patch reports that these efforts have gained momentum in dozens of communities nationwide, driven by a coalition of environmental activists, natural health advocates, and concerned citizens who question both the efficacy and safety of water fluoridation.

The controversy highlights the tension between established public health consensus and growing skepticism of government-mandated health measures, placing local water authorities and elected officials in the challenging position of navigating competing claims about a practice that affects virtually every resident in their communities.

Local Movements Gaining National Momentum

In the past year alone, more than 30 communities across 17 states have held referendums or council votes on removing fluoride from their water systems, with anti-fluoridation advocates succeeding in 14 of these initiatives. The Fluoride Action Network, an organization that tracks and advocates for ending water fluoridation, reports a significant increase in successful removal campaigns compared to the previous decade.

“We’re seeing unprecedented engagement at the local level,” explained Karen Johnson, coordinator for Citizens for Safe Drinking Water, a national network supporting local anti-fluoridation efforts. “Community members are increasingly asking fundamental questions about mass medication through public water systems and whether individuals should have greater choice in their exposure to fluoride.”

These local movements often follow a similar pattern, beginning with citizen-led initiatives to place fluoride removal on local ballots or pressure municipal water authorities directly. Pew Research Center data indicates public opinion on fluoridation has shifted noticeably in recent years, with support declining from 70% in 2015 to approximately 58% in their most recent survey, though attitudes vary significantly by region, education level, and political affiliation.

Scientific Debate and Recent Research

While major health organizations including the American Dental Association, the Centers for Disease Control and Prevention, and the World Health Organization continue to endorse water fluoridation as safe and effective, anti-fluoridation activists point to emerging research questioning both aspects of this consensus.

A significant development in the debate was the publication of a federally-funded study by the National Toxicology Program in 2022 that examined potential associations between fluoride exposure and cognitive effects. The National Institute of Environmental Health Sciences study, while not conclusive, found some evidence suggesting potential neurodevelopmental effects at exposure levels higher than those typically found in U.S. drinking water.

“The scientific literature is more nuanced than either side typically presents,” explained Dr. Michael Peterson, toxicologist and environmental health researcher at the University of Washington. “There’s reasonable consensus that water fluoridation at recommended levels reduces dental caries, particularly in populations with limited access to dental care. However, legitimate questions exist about potential risks in sensitive populations and the appropriate margin of safety for an intervention delivered through drinking water.”

Risk Assessment and Regulatory Approach

The Environmental Protection Agency, which regulates drinking water contaminants but not additives like fluoride, has maintained that fluoride levels up to 4 milligrams per liter are safe, though most fluoridated communities maintain concentrations between 0.7 and 1.2 milligrams per liter. The EPA’s regulatory framework for drinking water considers both health benefits and risks in establishing these guidelines.

“The regulatory approach to fluoride differs fundamentally from how we typically evaluate environmental contaminants,” explained environmental lawyer Sarah Richardson, who specializes in water quality regulations. “Because fluoride is intentionally added for health benefits, the risk-benefit calculation is more complex than for unintentional contaminants where the goal is simply minimizing exposure.”

This complexity is further illustrated by international differences in approach. The World Health Organization’s European Region reports that most European countries have opted against water fluoridation, instead focusing on topical fluoride applications, school dental programs, and fluoridated salt or milk as alternative delivery methods.

Information Landscape and Public Communication

The debate over fluoridation has become increasingly challenging for the public to navigate as conflicting claims proliferate across traditional and social media platforms. An analysis by Media Monitoring International found that anti-fluoridation content significantly outperforms pro-fluoridation messaging on major social platforms, with emotionally resonant personal narratives and appeals to natural health typically generating more engagement than technical scientific information.

“Public health communicators face an uphill battle in this information environment,” noted Dr. Emily Johnson, public health communication specialist at Johns Hopkins Bloomberg School of Public Health. “The nature of the fluoridation debate – involving complex scientific concepts, uncertainty, and deeply held values about individual choice – creates perfect conditions for polarization and misinformation to thrive.”

This communication challenge has led some public health organizations to revise their approach, moving away from purely technical arguments toward more value-centered messaging that acknowledges public concerns while presenting evidence for fluoridation’s benefits.

Environmental Justice Dimensions

The fluoridation debate has increasingly intersected with environmental justice concerns, as some advocates argue that universal water fluoridation minimizes disparities in dental health outcomes across socioeconomic groups. Research published in Health Affairs found that communities that have removed fluoride often see the largest negative impacts in neighborhoods with limited access to dental care.

“The equity implications of fluoridation decisions are substantial,” explained Dr. Robert Martinez, public health researcher specializing in health disparities. “In communities without fluoridation, we typically see greater disparities in dental caries rates between higher and lower income populations, particularly among children. This raises important questions about how to balance individual preferences with population-level health outcomes.”

However, anti-fluoridation advocates have also adopted environmental justice framing, arguing that universal water treatment removes individual choice and may disproportionately affect vulnerable populations with greater sensitivity to potential side effects. A 2023 study in the Journal of Public Health Dentistry explored these competing justice narratives, finding that both sides increasingly employ rights-based and equity arguments to support their positions.

Legal and Policy Landscape

The fluoridation debate has also entered the legal arena, with a significant case currently before the Ninth Circuit Court of Appeals challenging the EPA’s regulatory approach to fluoride under the Toxic Substances Control Act. Cornell Law School’s Legal Information Institute explains that this case represents the first time a citizen’s petition has advanced to trial under TSCA’s provisions allowing challenges to the regulation of chemical substances.

“This case could potentially reshape how we regulate substances added to drinking water,” noted environmental law professor Thomas Wilson of UCLA Law School. “It raises fundamental questions about the burden of proof for safety, the appropriate standard of evidence, and how agencies should weigh complex and sometimes conflicting scientific literature.”

At the local level, municipalities face varying legal frameworks regarding fluoridation decisions. Approximately 13 states have mandatory fluoridation laws requiring communities above certain population thresholds to fluoridate their water, while others leave the decision entirely to local authorities.

Looking Forward: Navigation Through Complexity

As the fluoridation debate continues, public health officials, researchers, and community leaders are searching for approaches that respect the complexity of the issue while avoiding unnecessary polarization.

“This isn’t simply a scientific question, but one that involves values around individual choice, the proper role of government, and how we make decisions under scientific uncertainty,” explained Dr. Sarah Thompson, medical ethicist at Georgetown University. “Moving forward productively requires creating space for these value considerations alongside rigorous evaluation of scientific evidence.”

Some communities have explored compromise positions, including offering fluoride-free water options at community fill stations, adjusting fluoride levels downward while maintaining some fluoridation, or enhancing alternative dental health programs when fluoride is removed. The CDC’s Division of Oral Health continues to update its technical recommendations as new research emerges, most recently revising the optimal fluoridation level downward in 2015 to account for increased fluoride exposure from other sources.

Meanwhile, the scientific community continues to investigate both the benefits and potential risks of water fluoridation, with several large-scale epidemiological studies currently underway that may provide clearer answers to some of the questions fueling the current debate.