In brief: OK drops fluoride recommendations, FDA meeting on ingestible fluoride, treating patients with dementia

Backlash after Oklahoma governor's decision on fluoride

Earlier this week, Oklahoma governor Ken Stitt issued an executive order ending the long-standing fluoride recommendations for drinking water. The Oklahoma Dental Association and Oklahoma State Medical Association have staunchly pushed back on this order.

Stitt's decision comes after earlier efforts to implement a "Make Oklahoma Healthy Again" campaign, which many have criticized for being heavy on slogans and light on actual strategies¹ for improving public health. Stitt's order was signed during a ceremony at the Capitol last Thursday, which was attended by Health and Human Services secretary, RFK Jr. Those in attendance were spotted with signs advocating for better plans and policies to improve Oklahoma's low national health-care standing.¹

On Stitt's decision, Dr. Steven Crawford, chairman of the Oklahoma Alliance for Healthy Families, said: "Taking fluoride from drinking water won't make Oklahomans healthier, but, more than likely, will decrease their health and increase health care costs."¹

According to the Oklahoma Dental Association, removing fluoride could increase tooth decay in the state by at least 25%. Rural and underserved communities may be particularly affected as using this water may be what they use in their oral hygiene routines.

Dr. Nicole Nellis believes Stitt's decision is a "dangerous step backward," especially considering safe water fluoridation has been around for seventy years.¹

Potential FDA decision on unapproved fluoride tablets

The FDA will be holding a meeting on July 23, 2025, to discuss the clinical use and safety of unapproved ingestible fluoride tablets designed to prevent tooth decay in children. This meeting will be conducted virtually and in person and will rely on input from clinicians, patients, and public health and research communities to come to a decision.²

Ingestible fluoride tablets have been around since the 1940s as a way to prevent caries in children living in areas with little to no water fluoridation; despite being prescribed to this day, they have never been formally approved by the FDA or removed from the market.

Previous concerns over fluoride consumption typically focused on the effects of fluoride levels higher than those found in prescription US drug products. However, these tablets are receiving special attention because they are predominantly given to young children. According to a recent notice by the Federal Register, "Some studies suggest an association between ingestible fluoride and several health effects, including on thyroid hormones, changes to the microbiome, and possibly decreased IQ. These safety findings are not conclusive, but they warrant continued research and discussion."²

You can learn more about this meeting from the Federal Reserve here.

You can learn more about this upcoming meeting on the FDA's website.

Maintaining oral health for dementia patients

Current geriatric care is focusing more heavily on patients with dementia as cases continue to rise in aging Baby Boomers. Symptoms range from misplacing common objects to experiencing severe mental fog-and for many in the "late stage" of this disease, maintaining an oral care routine is no longer feasible. Patients may refuse certain foods, suffer facial/gum swelling and tooth loss, bad breath, and irritability.³

So how can dental professionals and caretakers ensure their patients with dementia have healthy teeth and gums if they are unable to attend regular dental appointments? Depending on how debilitating their condition is, specific aids and methods can be implemented at home. This includes the following:

• Avoid electronic toothbrushes (the vibrations may disturb the patient, so opt for a child-sized toothbrush or one with soft bristles instead)

• Rinse with warm water instead of cold water

• Act out or verbally communicate brushing instructions

• Place a "storyboard" reminder of oral care instructions in the bathroom³

Information from Tufts University is available to learn more about how to care for patients with dementia.

References

1. Metzer S. Oklahoma medical groups blast governor's fluoride order. TulsaWorld. June 28, 2025. https://tulsaworld.com/news/state-regional/government-politics/article_0d5c2501-c45b-4438-8a4e-27df0fe04317.html

2. Use of orally ingestible unapproved prescription drug products containing fluoride in the pediatric population; public meeting; establishment of a public docket; request for comments. Federal Register. June 16, 2025. https://www.federalregister.gov/documents/2025/06/16/2025-10943/use-of-orally-ingestible-unapproved-prescription-drug-products-containing-fluoride-in-the-pediatric

3. Combining dementia care and dental care. NewsWise. June 25, 2025. https://www.newswise.com/articles/combining-dementia-care-and-dental-care