For decades, fluoride has been added to community water supplies to help prevent cavities. But since fluoride is also present in toothpaste and food, questions are emerging about its overexposure and potential health risks.
Robert F. Kennedy, Jr., the Trump administration’s new secretary of health and human services, has long called for an end to fluoridation in public water systems, citing health concerns. In response, many medical health associations, including the American Dental Association, have decried Kennedy’s views and reminded policymakers that fluoridating public water is considered “one of the 10 great public health achievements of the 20th century.”
Meanwhile, new research is emerging to help policymakers decide whether fluoridation should remain a public health standard. For the public, understanding fluoride’s benefits and risks can help people make their own decisions about it.
How Does Fluoride Protect Teeth?
Fluoride is a naturally occurring mineral found in soil, water, and certain foods like dairy, meat, and seafood. It plays a key role in oral health by strengthening tooth enamel, attracting calcium and phosphate to rebuild weakened areas, and creating a more acid-resistant surface that helps prevent cavities.
Fluoride can strengthen teeth through toothpaste and dental treatments. Children absorb it more than adults, making early intake especially impactful.
However, naturally occurring “fluorine” in water was once an alarming dental concern. At high levels, the mineral permanently turned children’s and adult’s teeth brown, even to the point of being “the color of chocolate candy,” the National Institute of Dental and Craniofacial Research said in an article on the US history of fluoridation.
By the 1940s, researchers figured out how to avoid both “fluorosis” and stained teeth. But they also saw there were fewer cavities in populations when there was a very low level of fluoride in the drinking water. In 1945, Grand Rapids, Michigan, became the first city to add fluoride—at tiny levels—to the public drinking water.
For 80 years, fluoride has been added in controlled amounts to many public water supplies through a process called water fluoridation. Compounds like sodium fluoride, fluorosilicic acid, or sodium fluorosilicate dissolve into the water supply, maintaining steady fluoride levels to help protect against tooth decay.
Many countries, including the US, UK, and Australia, continue this practice due to its proven effectiveness in combatting tooth decay.
A 2023 Environmental Research review of Australian studies from 1960 to 2022 indicated that fluoridated water reduces cavities by 26% to 44% across all age groups.
Beyond water and dental care, fluoride is also present in certain processed foods (such as brewed black tea), beverages made with fluoridated water, and dietary supplements designed for areas without fluoridated water supplies. A 2023 Environmental Research review of Australian studies from 1960 to 2022 indicated that fluoridated water reduces cavities by 26% to 44% across all age groups. As of 2020, 72.7% of the U.S. population receives fluoridated water through community water systems.
Regulatory Responses on Fluoride
While water fluoridation is a major source, toothpaste (especially when ingested) and certain foods may contribute significantly to overall fluoride intake, particularly in areas where people drink less tap water. This can lead people to worry that they may be consuming more fluoride than necessary. Besides dental fluorosis, which causes brown-stained teeth (a cosmetic issue), overexposure has been linked to a rare condition called skeletal fluorosis, in which bone structure changes to become more brittle and less elastic, potentially leading to joint pain and bone damage.
There are also studies pointing to lower IQs and other cognitive harms in children who ingest too much fluoride. The US federal government‘s National Toxicology Program began studying published research on fluoride in 2015. In January 2025, it concluded, “with moderate confidence, that higher levels of fluoride exposure, such as drinking water containing more than 1.5 milligrams of fluoride per liter, are associated with lower IQ in children.” Its research was published on January 6, 2025, in JAMA Pediatrics.
In response to these concerns, health and environmental agencies have introduced guidelines and limits to help regulate fluoride exposure while trying to maintain its dental benefits.
Regulatory Action and Recommendations
1986: The Environmental Protection Agency (EPA) set a legal fluoride limit of 4 mg/L in drinking water to prevent bone disease and dental fluorosis.
2011: The EPA and U.S. Department of Health and Human Services proposed lowering fluoride concentration to 0.7 mg/L to balance cavity prevention with the risk of fluorosis.
2013: The European Food Safety Authority (EFSA) recommended a daily intake limit of 0.05 mg/kg body weight per day for children and adults.
2015: The US Public Health Service (PHS) lowered its recommended level from 1.2 mg/L to 0.7 mg/L due to increased fluoride exposure from multiple sources. The 0.7 mg/L recommendation was finalized but remains optional for states.
September 2024: A federal judge ordered the EPA to reevaluate fluoride regulations in drinking water due to concerns about its effects on children's intellectual development.
As research continues, policymakers are re-examining fluoride standards to ensure public health safety.
Policy Shifts to Balance Benefits and Risks
While major health organizations continue to support fluoridation, some countries and US regions are reconsidering their approach. Countries like Germany, Sweden, and Switzerland have discontinued water fluoridation but still promote fluoride use through fortified salt and targeted dental programs.
Meanwhile, several US cities and states, including Lebanon, Oregon, and Arkansas, have moved toward reducing or eliminating fluoridation. Florida’s State Surgeon General has also questioned the necessity of fluoridated water, citing the need for further evaluation of its long-term effects.
“The difference in dental health outcomes between non-fluoridated and fluoridated waters in an urban setting with access to dental care and a community where folks actively visit dentists for preventative care would be minuscule.”
“The difference in dental health outcomes between non-fluoridated and fluoridated waters in an urban setting with access to dental care and a community where folks actively visit dentists for preventative care would be minuscule,” says Rohini Agarwal, a dentist at Smilecloud Family Dental in Dallas, Texas, “The more pronounced impact is in areas where families are not actively invested in oral health.”
So, families regularly visiting the dentist and prioritizing tooth health may want to find ways to reduce their fluoride exposure.
How to Reduce Fluoride Exposure
Those who are worried about fluoride intake can limit exposure while keeping their teeth healthy:
Use a water filtration system that uses reverse osmosis and activated alumina filters.
Choose fluoride-free bottled or filtered water.
Limit tea, seafood, and processed foods made with fluoridated water.
Use fluoride-free toothpaste and mouthwash.
Brush and floss twice a day and reduce sugar intake to prevent cavities.
Consider hydroxyapatite toothpaste as a natural alternative to help remineralize enamel.
According to Kevin Gast, CEO and Co-Founder of VVater, a water technology company, “The risk lies in overexposure, and the combination of fluoride in water, fluoride in your toothpaste, mouthwash, and other sources of fluoride is the high-risk factor. It is strongly advised to be selective in your products to minimize your risk of ‘overdosing’ on fluoride. Using the latest water treatment technologies to remove fluoride from your water makes a big difference, but also using fluoride-free toothpaste, mouthwash, and avoiding various processed foods and drinks that contain fluoride.”
“The risk lies in overexposure, and the combination of fluoride in water, fluoride in your toothpaste, mouthwash, and other sources of fluoride is the high-risk factor. It is strongly advised to be selective in … products to minimize [the] risk of ‘overdosing’ on fluoride.”
By examining how much fluoride one is exposed to, one can manage the amount and maintain good oral health.
Making an Informed Choice
The debate over fluoride isn’t settled. While it’s been used for decades to help prevent cavities, research continues to uncover the long-term effects and impact of overexposure.
If concerned about fluoride, start by checking the local water report, asking the dentist about one’s fluoride intake, and looking into fluoride-free alternatives. Whether people support fluoridation for its benefits or prefer to avoid it, staying informed helps one make the best choice for their health.
*Kelcie Ottoes is a copywriter for sustainable businesses. She specializes in long form content with a call to action and has worked with brands like Farm Journal, Pela, ZeroHero, and more.