SALT LAKE CITY — Utah has notably become the first state in the United States to prohibit the use of fluoride in public drinking water, despite strong opposition from dentists and national health institutions. These critics warn that the decision could have adverse medical effects, particularly impacting low-income communities negatively.
Republican Governor Spencer Cox signed the legislation on Thursday, effectively preventing cities and communities from deciding whether to include this mineral in their water systems. Similar legislative measures are under consideration in Florida, Ohio, and South Carolina, while in other states like New Hampshire, North Dakota, and Tennessee, such proposals have been rejected. In Kentucky, a bill proposing optional fluoridation stalled in the state Senate.
The American Dental Association (ADA) strongly condemned the new Utah legislation, describing it as a “wanton disregard” for the oral health and welfare of Utah’s residents. They underscored that cavities remain the most prevalent chronic childhood disease. According to the U.S. Centers for Disease Control and Prevention, fluoride bolsters teeth by replenishing minerals lost during normal wear and tear, thereby reducing cavities.
Denver dentist Brett Kessler, president of the ADA, expressed disappointment. “As a father and a dentist, it is disheartening to see that a proven public health policy, which exists for the greater good of an entire community’s oral health, has been dismantled based on distorted pseudoscience,” stated Kessler.
Some legislators have raised health concerns over fluoride, considering it detrimental to public health. The Utah ban, effective starting May 7, has brought concerns over water fluoridation—a topic that has long been dismissed as a fringe belief—into the mainstream conversation. This legislative move coincides closely with skeptic Robert F. Kennedy Jr.’s appointment as U.S. health secretary. Kennedy had previously indicated that a Trump administration would advise water systems nationwide to eliminate fluoride.
Governor Cox, who spent his upbringing and raised his children in a non-fluoridated water community, equated the practice to medication administered by the government. Utah lawmakers, in supporting the ban, argued that it was a matter of personal health choice and cited cost concerns related to water fluoridation.
Florida’s surgeon general, last year, advised against community water fluoridation due to perceived “neuropsychiatric risks.” This guidance came on the heels of a federal judge’s decree mandating the Environmental Protection Agency to regulate fluoride in drinking water, as excess amounts could potentially hinder children’s intellectual development. A federal review last year indicated a link between high fluoride exposure and diminished child IQ scores. However, these studies involved fluoride levels significantly above current federal guidelines.
The National Institutes of Health (NIH) asserts that obtaining a toxic dose of fluoride via water is nearly impossible, noting that harmful fluoride doses are rare, typically stemming from accidents or incorrect supplement administration. Standard water fluoridation or toothpaste use does not pose such risks. Occasionally, communities may exceed recommended fluoride levels, mainly due to natural occurrences. In 2011, it was reported that two in five U.S. adolescents exhibited mild dental streaking or spotting due to overexposure to fluoride.
Since 2015, a 0.7 milligrams per liter fluoride level in water has been the federal recommendation, compared to the previous upper limit of 1.2 milligrams per liter, an adjustment reflecting a growing understanding of fluoride’s effects.
Many regard adding small amounts of fluoride to drinking water as one of the significant public health achievements of the past century, mainly due to its cost-effectiveness in preventing widespread tooth decay. Since 1950, water fluoridation has been federally endorsed to counteract dental decay, remaining a priority even after fluoride toothpaste became widely available. Today, over 200 million U.S. citizens, accounting for nearly two-thirds of the population, receive their water fluoridated by public water systems.
According to the Utah Dental Association, fluoridation can reduce cavities by at least 25% across all age groups. Supporters of continued water fluoridation in Utah argue that banning it could disproportionately affect low-income residents who rely on it as their primary preventive dental care method.
The primary sponsor of Utah’s legislation, Republican Representative Stephanie Gricius, conceded to fluoride’s benefits but framed the issue around “individual choice” in water consumption. Out of 484 water systems in Utah that reported their data for 2024, only 66 systems implemented water fluoridation, including Salt Lake City, the state’s largest community. According to CDC rankings, in 2022, Utah was placed 44th in the nation concerning the percentage of its residents receiving fluoridated water.