Kids will develop 25.4 million more cavities if fluoride is banned nationwide, study finds

A national ban on the mineral fluoride in U.S. public drinking water could result in a decayed tooth for one out of every three children, researchers said on Friday.

A model estimating the potential impact on children’s dental health and its costs found that it would result in a 7.5 percent increase in tooth decay, translating to 25.4 million more teeth. It would also cost an additional $9.8 billion over the course of five years, and $19.4 billion after 10 years.

“Fluoride replaces weaker ions within tooth enamel, making it stronger and less susceptible to tooth decay caused by bacteria,” Dr. Lisa Simon, a founding member of the system and a physician at Brigham and Women’s Hospital, said in a statement. “There’s strong evidence from other countries and cities, such as Calgary in Canada, showing that when fluoride is eliminated, dental disease increases. Our study offers a window into what would happen in the United States if water fluoridation ceased.”

Simon was the senior author of the findings, which were published on Friday in the journal JAMA Health Forum.

Fluoride, a naturally occurring mineral found in the soil and water, has been used to help strengthen tooth enamel for decades. It was first added to public water systems in 1945. It has been deemed one of 10 great public health interventions of the 20th century because of the dramatic decline in cavities since then.

Recently, however, states have acted to implement their own bans. The first was in Utah, and Florida followed suit a few weeks later.

The bans come as Health and Human Services Secretary Robert F. Kennedy, Jr., told The Associated Press last month that he would instruct the Centers for Disease Control and Prevention to stop recommending fluoridation in drinking water. Kennedy has cited a widely controversial study related to IQ that has been criticized by experts.

But dentists say doing so would be costly to the health of Americans — and especially low-income or rural families who may rely on fluoride in drinking water as a cost-effective way to protect their teeth.

Children with limited access to dental care are expected to be the most affected by a ban.

“Dental cavities disproportionately affect disadvantaged children,” Dr. Tomitra Latimer, an assistant professor of pediatrics at Northwestern University Feinberg School of Medicine, said in a statement. “That includes kids with autism, Down syndrome or cerebral palsy, who may take sugary medications or struggle with brushing.”

The authors of the JAMA study found that a national ban would substantially increase dental decay and costs, particularly for publicly insured and uninsured children.

To develop the model, the researchers used detailed oral health and water fluoridation data in the National Health and Nutrition Examination Survey that was collected from 8,484 children ages 19 and below. Then, they simulated two scenarios over periods of five and 10 years. One would maintain current fluoride levels, and the second would eliminate fluoride from public drinking water. They ran the simulation 1,000 times.

The number of fluorosis cases — the discoloring of tooth enamel due to excessive fluoride intake — decreased by 0.2 million.

The study did not look at cognitive effects from fluoride exposure, saying that current levels of fluoride in public water are not associated with worse neurobehavioral outcomes. The current recommended fluoride level in public water systems is 0.7 milligrams per liter.

“We know fluoride works. We’re able to show just how much it works for most communities and how much people stand to lose if we get rid of it,” said Simon.

“Extensive research confirms the recommended level significantly reduces dental cavities without posing health risks,” Latimer said.