Kids' cavities would increase by millions if every state banned fluoride, study finds

www.nbcnews.com

Rotten result? Kids' cavities would increase by millions if every state banned fluoride

Florida and Utah have already removed fluoridation from public water systems. What if the rest of the country follows?

The long-term effects of banning fluoride from public drinking water across the country could cost families billions of dollars and result in millions of rotten teeth, a new analysis predicts.

The study, published Friday in JAMA Health Forum, shows that if all 50 states stopped community water fluoridation programs, kids in the U.S. could expect to develop 25.4 million more cavities within the next five years.

That’s the equivalent of a decayed tooth in 1 out of every 3 children.

The number of cavities would more than double in 10 years, to 53.8 million.

75 comments

I hate just how the fluoride conspiracy theory is still a thing when it's been proven time and time again that fluoride is needed to maintain healthy dental hygine.
- I think calling it a conspiracy theory is not entirely fair. It's a genuine scientific debate, hindered by the lack of proper evidence and studies that apply to the US.
  Read https://www.statnews.com/2025/01/06/fluoride-iq-jama-pediatrics-critiques-meta-analysis/ for example, it highlights a recent meta-study that found a small, but non-negligible effect on neurodevelopment if people were ingesting fluoride. But a lot of studies it relies on have some asterisks attached. Those are properly accounted for in the meta-study, but ultimately the answer is "we don't really know".
  Many western countries don't add fluoride to the drinking water; many used to do so in the past but stopped. There were the concerns about neurotoxicity (albeit minor) but also some ethical concerns regarding mass-medicating the population without any realistic opt-out. But the other major reason is that those countries have the population exercise good dental practices like brushing twice a day with fluoridated toothpaste, which is spat out instead of swallowed. This avoids concerns of neurotoxicity but maintains the dental benefits: a best of both worlds basically (also endorsed by most scientists).
  The US has systemic poverty issues, and a large part of the population do not observe these good dental practices, not necessarily through ill-will but rather because they lack the money to buy toothpaste. Because of that, removing fluoride will likely increase cavities in the US, unlike in other western countries.
  Ideally the US keeps the fluoride around until these systemic poverty issues are largely resolved. But knowing the current shitstains in government...
- They know it's bullshit, they're just using it to sell the idea to morons.
  The point is actually the increase in cavities. They want to make it even more expensive to be poor, with the ultimate goal of starving out anyone who isn't profitable.
  
  They know it's bullshit, they're just using it to sell the idea to morons.
  I agree, although I would say the misinformed and decieved because this is all caused by the top 1%.
  The point is actually the increase in cavities. They want to make it even more expensive to be poor, with the ultimate goal of starving out anyone who isn't profitable.
  Exactly, this is why I find the current misinformation/data enshitification landscape to be quite insidious as actions like this only widens the wealth gap with poorer people suffering more for the benefit of the rich.
  Same situation but in the tech field:
  NVIDIA's Dirty Manipulation of Reviews
- I hate just how the fluoride conspiracy theory is still a thing when it’s been proven time and time again that fluoride is needed to maintain healthy dental hygine.
  People who believe in disprovable conspiracy theories, literally don't care about the truth.
  They don't think it might be true, they think they know it's true. They've convinced themselves that since they have "seen through the lies" and learned "secret knowledge", that makes them smarter than everyone who dismisses their theory. And the majority are so far gone that they're extremely afraid of admitting they were wrong. Since they've spent years rolling their eyes and joking about how dumb other people are. And if they admit they were wrong, they have to admit to themselves that all that time they were actually the dumb one. So usually they double down even in the face of evidence they produced themselves.
  TL;DR: Most conspriacy theorists are stupid and think their theory proves them a genius. That's why the weird ones persist.
- People would find a way to demonize vitamin B if the government had a program to supply it to people for free.
- But why put it in the water and drink it, better to have in in toothpaste and mouthwash if you can't brush
  
  Because it's shown that adding it to the drinking water is safe for human consumption and at the same time causes significantly lower dental issues. It's a jet positive, always has been
  
  It actually works much better in salt: your teeth are exposed to higher concentrations of fluoride for longer periods of time, yet you consume less total fluoride. Plenty of countries fluoridate salt much like we iodize it.
  
  Poor people. To repeat myself:
  Poor people often can’t afford toothbrushes and/or toothpaste, let alone the “recommended” (read: mandatory, or people will say you deserved to lose your teeth) floss, mouthwash, electric toothbrush, etc., all from “reputable brands”.
  
  Fair point. Although I've used my 2$ toothbrush for two years now. I think even if you're poor you could get a toothbrush. Even if you don't afford toothpaste just brushing goes a long way.
  
  My cousins never brush their teeth, but they drink tap water. Their teeth has outlasted their parents teeth by 10 years and counting
- Is fluoride the only option? Is not hydroxyapatite in toothpaste as effective as fluoride in toothpaste and cannot it be used as replacement for fluoride in toothpaste?
  
  Wikipedia: Hydroxyapatite#SafetyConcerns
  The European Commission's Scientific Committee on Consumer Safety (SCCS) reissued an updated opinion in 2023, where it cleared rod-shaped nano hydroxyapatite of concerns regarding genotoxicity, allowing consumer products to contain concentrations of nano hydroxyapatite as high as 10% for toothpastes and 0.465% for mouthwashes. However, it warns of needle-shaped nano hydroxyapatite and of inhalation in spray products.
  Based off the article and the cited Opinion document by the EU's safety committee (SCCS) it seems like rod-shaped nano hydroxyapatite is safe for use in only toothpaste provided that at least 95.8% (particle count) are comprised of rod-shaped instead of needle-shaped particles and in addition are not coated or surface modified.
  composed of rod-shaped particles of which at least 95.8% (in particle number) have an aspect ratio of less than 3, and the remaining 4.2% have an aspect ratio not exceeding 4.9;
  I'll be honest in that a bit of this sentence especially regarding the aspect ratio is somewhat incomprehensible to me as the sentence structure obscures what they're trying to communicate.
  
  I believe by aspect ratio, they mean the ratio of diameter to length of the rod shaped structures. At an aspect ratio of less than 3, the structures are more cylinder shaped than rod shaped.
  So the minerals must be mostly stubby cylinder shaped, and less than 4.2% can be needle shaped or long rod shaped. Same problem we had with asbestos actually, that the long thin needle shaped fibers were physically damaging to tissue.
- Fluoride is certainly needed for cavity protection. But. Fluoride was added to water before its mechanism of action was understood.
  It was known that people who had naturally-present fluoride in their wells had fewer cavities, so they started emulating the fluoride concentration in city water. Which worked.
  But.
  We have since learned that fluoridated toothpaste and mouthwash provide more than sufficient quantities of fluoride, such that there is no longer a significant difference between people with fluoridated public water supplies and people with private wells lacking fluoride.
  Fluoridated water isn't harmful. But it's not actually beneficial anymore.
  
  You underestimate poverty and child neglect a lot
  
  You mean State neglect. Toothpaste should be free if you're poor
  
  Extend that out.
  All basic health care products should be free for everyone regardless of income.
  
  If they're so neglected they're not brushing their teeth, fluoride in the water is not going to help much.
  
  Demonstrably false
  Obviously floride in water is not a substitute for toothpaste, but it has been shown to have the greatest effects amongst the poorest children. Spreading lies just leads to poor kids with cavities
  https://pmc.ncbi.nlm.nih.gov/articles/PMC6439886/
  https://www.sciencedirect.com/science/article/abs/pii/S0300571200000051
  
  Maybe I'm not spreading lies, maybe I'm merely misinformed. Fuck off. Great way to get me listening to you.
  
  Of course it's beneficial. That's the whole point of the article, right? That's why the data was presented the way it was presented.
  Are there other ways to generate the same positive effects across large swaths of the population, and especially among poor people? Yes. But most of those ways are very expensive and intrusive.
  
  Fluoride is beneficial. Putting fluoride in something that we use is beneficial. But, once you put reasonable concentrations in toothpaste, the trace amounts in water provide no additional benefit.
  I'm not saying we should get rid of fluoridation. I'm not saying we should keep it. I'm saying that there is no good reason for outrage one way or another.
  Fluoridated water is not an adequate replacement for proper dental hygiene. Getting toothpaste and toothbrushes to poor people is infinitely more important than fluoridated water, and I'll save my own outrage for universal healthcare, including dental.
  This particular hill ain't worth dying on.
  
  You're saying lies. Modern studies have shown fluoride in water benefits the poorest children. These are the most vulnerable populations with limited access to dental care (at home and professional).
  Stop spreading lies. No it doesn't fully replace toothpaste, but there is a demonstrable benefit
  https://pmc.ncbi.nlm.nih.gov/articles/PMC6439886/
  https://www.sciencedirect.com/science/article/abs/pii/S0300571200000051
  
  With or without fluoridated water, the poorest kids have the worst dental health. Fluoridated water significantly - but only partially - improves dental health for the poorest kids.
  Rural kids on private, non-fluoridated wells have sufficient dental health despite no access to fluoridated water. They get the majority of their fluoride the same place you get the bulk of your fluoride: toothpaste.
  If we are going to rely on passive fluoridation instead of toothpaste, salt is a superior delivery method. Fluoridated salt is used to reach nearly 100% of the populace in many countries, At most, fluoridated water is only available to about 80% of the US. Fluoridated salt allows higher concentrations of fluoride in saliva with lower total consumption.
  We only use fluoridated water to duplicate the original discovery. It's actually a piss-poor delivery method.
  These are the most vulnerable populations with limited access to dental care (at home and professional).
  This "limited access" should be pissing you off infinitely more. Anything less than the "access" you are talking about should be considered neglect. Fluoridated water is only beneficial if we are actively neglecting out kids. When we stop neglecting them, fluoridated water serves no purpose.
  
  You're dying on the "poor kids should have cavities hill" whether or not you realize it. It is shown to work and provide better dental health to the most vulnerable populations. I'm sorry you don't like the facts or the science behind it.
  I'm sorry it's not a perfect system, but removing it does nothing but harm. Of course we should be providing everyone access to dental and Healthcare. We can have that conversation AND prevent what we have now that's helping kids from being taken away. You don't take away what you have before providing the improvement.
  Now quit advocating/defending the stances of Trump/Republicans and advocate instead for those that will be suffering.
  
  Fluoridated Salt. Toothpaste. Universal healthcare. I keep throwing out vastly superior options, and you keep coming back to the status quo.
  Pivot toward progress. They want to kill off a program. What would you need them to agree to before yoy would be willing to let it go?
  Fluoridated water only benefits neglected kids. If we didn't have neglected kids, we wouldn't need fluoridated water. What can we do to ensure kids aren't neglected? Let's pivot to that. Let's demand that.
  They can get their "win" on something that doesn't matter, and we can get our win on something that actually does.
  Progress. To hell with the status quo.
  
  You are still missing the point.
  One the government will not be bringing those things into effect now. And before you say it neither of us will be starting an armed revolution so save that rhetoric, but you are welcome to prove me wrong.
  Two, you do not end the safety net before you implement the solution. That will only cause harm.
  Three, I can fight to maintain access to something that helps poor children today AND pursue a better solution.
  All you're doing is supporting the rhetoric of the Republicans and advocating to harm children.
  We should strive to be better, but we shouldn't pull away access to our basic social safety nets before we replace them. We should do that only after the better system is in place
  
  You're still advocating the status quo. You are not advocating the "solution".
  Instead of actively advocating for improvement, you're actively advocating dragging our feet against Republicans advancing their agenda. You're advocating slowing their regression. You're not advocating progress yourself. You're only trying to slow them down.
  You accuse me of missing the point; I assure you, I haven't. I am very well aware that harm will arise if no alternative is enacted. I am trying to redirect your attention toward superior alternatives, but you seem hell bent on buttressing the status quo rather than seeking improvement. You're playing a weak defense. You need to go on the offensive.
  
  I don't know what fantasy land you live in, but there is no way this government will be implementing any progressive reform. Cool dream, but it's not happening. And they certainly won't be preemptively enacting it.
  Once again I'm all for your progressive solutions. They sound great, but this government will not enact them. Even if they would they will remove the existing system before hand causing harm and suffering.
  Harm and suffering you keep supporting for some reason.
  
  This was my understanding as well. Also, high fluoride concentrations can be deleterious, but those concentrations aren't found in our water supplies.

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