New study projects economic and oral health effects of fluoride removal

Findings from a study by the Journal of the American Medical Association (JAMA) coauthored by ADA president Brett Kessler, DDS, and Scott D. Smith, DDS, MS, predict significant increases in dental disease and treatment costs if community water fluoridation were discontinued in the United States.¹

Public opinion and debate

Recent discourse questioning fluoride's safety and efficacy has led to widespread apprehension in the United States, with secretary of Health and Human Services (HHS) RFK Jr. speaking out against its "dangerous side effects" earlier this year, particularly that it lowers IQ scores in children. Since then, the ADA has contested his statements and urged for proper education when it comes to fluoride - noting that it has always been safe to ingest in regulated doses.²

Projected impacts of fluoride bans on low-income communities

In August, a poll from the CareQuest Institute of Oral Health revealed that overall, Americans are supportive of fluoride with only 6% of the 1114 survey participants being in favor of banning it. Per the findings in JAMA, 25 million additional children will be experiencing dental caries if a ban is enacted. As a result, almost $10 billion more will be spent within five years to fix incipient dental problems. According to researchers: "If today's Medicaid funding allows for comprehensive dental care for 1000 children, increased decay from fluoride removal from water systems means that same budget might only cover 700-effectively cutting care for 300 kids."¹

With a surfeit of dental disease combined with a limited Medicare budget, the country will not be able to meet the needs of every patient. Not only will low-income families be unable to afford proper dental care, but dental clinics situated in rural communities will not have an adequate staff to manage higher patient volumes.

To put into perspective how many potential cases of caries and dental diseases could arise from unfluoridated water, JAMA highlighted data from a study done in Juneau, Alaska; children enrolled in Medicaid experienced up to a 47% increase in cavity-related treatment costs within nine years of fluoride cessation. And as it stands, roughly 100 million Americans do not see their dentist each year.³

Professional response

In a press release from May of this year, Dr. Kessler said the following about the impending oral health disparity: "It's time we stopped debating irresponsible and misinformed actions like what is happening in states like Florida and Utah and recognize the serious consequences if we discontinue fluoride in water programs or in dental products."

References

1. Kessler B, Smith SD. Removing fluoride from water?: An oral health crisis unfolds. JAMA Health Forum. 20255;6(9):e253296. doi:10.1001/jamahealthforum.2025.3296

2. Fluoridation FAQs. American Dental Association. https://www.ada.org/resources/community-initiatives/fluoride-in-water/fluoridation-faqs

3. Removal of fluoride from water will cost billions and deteriorate oral health. American Dental Association. May 30, 2025. https://www.ada.org/about/press-releases/removal-of-fluoride-from-water-will-cost-billions-and-deteriorate-oral-health