Removing Fluoride From Water Could Increase Tooth Decay in Children

Fluoride in drinking water has been a long-standing public health measure aimed at improving dental health. However, recent policy discussions and legislative actions in several regions have raised questions about whether fluoride should continue to be added to public water systems. A new analysis highlights potential consequences of removing fluoride, particularly for children, and suggests that doing so may lead to a noticeable rise in tooth decay and related healthcare costs.

The report, conducted by researchers at the CareQuest Institute for Oral Health, examines what could happen if multiple states discontinue water fluoridation. According to their findings, more than 132,000 additional children could require dental treatment within just three years if fluoride is removed in five states. These treatments could include fillings, tooth extractions, and other procedures that are often necessary when cavities go untreated.

The financial impact is also significant. The analysis estimates that Medicaid costs alone could increase by nearly $40 million due to the rise in dental issues among children. Medicaid currently provides healthcare coverage for approximately 37 million children in the United States, many of whom already face barriers to accessing regular dental care.

The states highlighted in the analysis include Florida, Kentucky, Louisiana, Missouri, and Oklahoma. Florida has already implemented a ban on fluoride in public water systems, while the others are considering similar measures. In Florida specifically, researchers estimate that more than 52,000 additional children could require dental care following the ban.

To understand the implications, it is important to look at how fluoride works. Fluoride strengthens tooth enamel, making it more resistant to acid attacks caused by bacteria in the mouth. This protective effect helps prevent cavities from forming, especially in children whose teeth are still developing. Tooth decay can begin very early in life, sometimes even before a child’s first tooth emerges, which makes early prevention strategies particularly important.

Public health organizations have long supported water fluoridation as a safe and effective measure. The Centers for Disease Control and Prevention has reported that community water fluoridation has reduced tooth decay by about 25 percent over time. This reduction applies to both children and adults, making it one of the most widely recognized preventive health interventions.

Despite its benefits, fluoride has become a topic of debate in recent years. Some individuals and policymakers have raised concerns about potential health risks associated with fluoride exposure. These concerns have led to increased legislative activity, with at least 21 states introducing bills aimed at limiting or banning fluoride in public water systems.

One of the key concerns involves the possibility of negative health effects at high levels of fluoride exposure. Research has indicated that excessive fluoride intake could be linked to neurological and developmental issues. For example, a 2025 study from the National Institute of Environmental Health Sciences found an association between higher fluoride exposure and lower IQ scores in children. However, it is important to note that many of these studies examined populations exposed to fluoride levels significantly higher than those typically found in regulated public water systems in the United States.

Health experts emphasize that the dosage of fluoride is a critical factor. The recommended level in drinking water is 0.7 milligrams per liter, which is considered both safe and effective for preventing tooth decay. This amount is relatively small, often compared to just a few drops in a large volume of water, yet it provides meaningful protection for dental health.

Another important aspect of the discussion is access to dental care. Many children, particularly those from low income families, do not receive regular dental checkups. When dental problems are not addressed early, they can worsen over time and lead to more serious complications. In some cases, families may turn to emergency rooms for treatment, which is both costly and less effective than preventive care.

Experts warn that removing fluoride from water systems could exacerbate these challenges. Without the protective benefits of fluoride, children may be more likely to develop cavities at a younger age. Dentists in areas where fluoride has been removed may begin to see an increase in dental issues relatively quickly, especially among younger patients whose teeth are more vulnerable.

In addition to health and financial considerations, there is also a broader public health perspective. Water fluoridation is often described as a population wide intervention that benefits everyone, regardless of income or access to healthcare services. Unlike individual treatments, it does not require active participation, making it particularly valuable for reaching underserved communities.

The ongoing debate highlights the need for careful evaluation of both the benefits and risks associated with fluoride use. Policymakers must consider scientific evidence, public health outcomes, and the potential long term impact on communities when making decisions about water fluoridation.

While concerns about safety should not be dismissed, current evidence continues to support the use of fluoride at recommended levels as a safe and effective way to prevent tooth decay. Removing it without implementing alternative preventive measures could lead to unintended consequences, particularly for children who are already at higher risk of dental problems.

As discussions continue, it is essential for individuals and families to stay informed and consult with healthcare professionals when making decisions about their oral health. Preventive practices such as regular brushing, flossing, and dental visits remain crucial, regardless of whether fluoride is present in drinking water.

Sources:
NBC News, March 19, 2026
CareQuest Institute for Oral Health analysis
U.S. Centers for Disease Control and Prevention (CDC)

Disclaimer:
This article is for informational and educational purposes only. It is not intended to provide medical advice, diagnosis, or treatment. Statistical data reflects general trends and may not apply to individual circumstances. Always consult a qualified healthcare professional for personalized medical guidance.