Removing fluoride from U.S. water systems could increase dental costs by billions, Harvard study finds
A newly published study in the JAMA Health Forum has revealed that removing fluoride from public drinking water in the United States could lead to an estimated $9.8 billion increase in dental treatment costs over five years. The research, led by experts at Harvard University and Brigham and Women’s Hospital, highlights the essential role of fluoride in preventing tooth decay, particularly in children.
The simulation-based study projects a 7.5% increase in decayed teeth, totaling 25.4 million additional decayed teeth—roughly one for every three American children—if water fluoridation were eliminated nationwide.
Why fluoride matters for oral health
The study emphasized fluoride’s proven track record in supporting preventive dentistry, especially in vulnerable populations.
“Fluoride replaces weaker ions within tooth enamel, making it stronger and more resistant to bacterial decay,” said Dr. Lisa Simon, senior author and a dentist-physician at Brigham and Women’s Hospital.
While the analysis showed that fluorosis—a cosmetic side effect of excessive fluoride—would decrease by approximately 200,000 cases, the resulting spike in cavities would cause total dental expenditures to balloon to $19.4 billion over ten years.
Study methodology, credibility
Researchers used data from 8,484 children aged 0–19, compiled through the National Health and Nutrition Examination Survey (NHANES). A microsimulation model compared two scenarios: maintaining current fluoride levels and eliminating fluoridation. The model was run 1,000 times to ensure robust predictions and account for real-world variability.
Lead author Dr. Sung Eun Choi, a Harvard professor of oral health policy and epidemiology, stated, “This approach ensures our estimates reflect a wide range of real-world outcomes with scientific rigor.”
Calgary cited as real-world example
The U.S. study used Calgary, Alberta, as a key case study. The Canadian city removed fluoride from its water supply in 2011, only to see a notable rise in dental disease, especially among school-aged children.
In response, the City of Calgary voted to reintroduce fluoride, with implementation expected to begin on June 30, 2025, after a 62% approval rate in a municipal plebiscite during the 2021 election. A 2021 study by the University of Calgary’s Cumming School of Medicine found that Calgary Grade 2 students had higher cavity rates compared to those in Edmonton, where water has been fluoridated since 1967.
A public health turning point
The study’s findings arrive amid rising fluoride skepticism. Florida recently became the second U.S. state to ban water fluoridation, following Utah. U.S. Health Secretary Robert F. Kennedy Jr., a known fluoride critic, has controversially labeled fluoride as “industrial waste” and linked it to cognitive issues like reduced IQ—claims that lack broad scientific consensus.
Despite this, public health authorities continue to back fluoridation as a safe and effective tool to prevent dental caries, especially in children and underserved communities.
“There’s strong evidence from other countries and cities showing that when fluoride is eliminated, dental disease increases,” Dr. Simon concluded. “Our study offers a data-driven window into what would happen in the United States if water fluoridation ceased.”
First introduced in 1945 in Grand Rapids, Michigan, water fluoridation has long been recognized as a top public health achievement, supported by organizations like the CDC, WHO, and American Dental Association.
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