As a dentist in Boston, we are deeply concerned to learn that Utah has become the first U.S. state to ban fluoride in public drinking water. Governor Spencer Cox signed the legislation on March 28, 2025, preventing cities and communities from adding fluoride to their water systems. This decision has reignited debates about personal choice, public health, and the role of science in policy-making. While it’s crucial to acknowledge concerns about fluoride, the historical and scientific evidence overwhelmingly supports its benefits.
Addressing Anti-Fluoridation Concerns
Opponents of fluoridation often raise concerns about individual autonomy, potential health risks, and the ethics of mass medication. While personal choice is an important consideration, it must be balanced against the collective benefits of public health measures. The scientific consensus confirms that fluoride, when used at optimal levels, is safe and highly effective. The levels recommended for drinking water (0.7 parts per million) are far below the thresholds that could cause harm. Claims linking fluoride to severe health risks, such as cancer or neurological issues, have been repeatedly debunked by decades of research from institutions like the National Institutes of Health and the CDC.
Even assuming that the scientists are somehow wrong about the negative health effects of fluoride at such small levels, one must compare the dangers to those of tooth decay. One of the most overlooked consequences of removing fluoride is the significant rise in dental caries (tooth decay) and the long-term health effects they bring. Cavities are not just a minor inconvenience; they can lead to severe infections, chronic pain, tooth loss, and even death. When left untreated, tooth decay can contribute to broader health issues such as cardiovascular disease, diabetes complications, and increased risks of systemic infections.
Children are particularly vulnerable to the effects of tooth decay. Pain from untreated cavities can interfere with school performance, nutrition, and overall well-being. In extreme cases, untreated dental infections can lead to life-threatening conditions. The tragic case of Deamonte Driver, a 12-year-old Maryland boy who died from an untreated tooth infection that spread to his brain, is a stark reminder of how oral health can have deadly consequences. Without fluoride in Utah’s water supply, we risk seeing more cases of preventable dental diseases escalating into serious medical emergencies.
This is an unnecessary risk, especially since many of the concerns about fluoride are not supported by credible scientific evidence. For example, some anti-fluoride activists claim that fluoride lowers IQ levels. However, large-scale studies suggest otherwise. A comprehensive review by the National Academies of Sciences in 2020 found no consistent or conclusive evidence linking water fluoridation at recommended levels to cognitive decline. In fact, average IQ scores in fluoridated countries have risen over the decades following the introduction of water fluoridation, a trend that aligns with improvements in public health, education, and nutrition rather than any supposed negative effect from fluoride. Furthermore, a 2014 study published in American Journal of Public Health found no difference in IQ scores between children in fluoridated and non-fluoridated communities in New Zealand. The continued spread of misinformation on this topic detracts from the well-established benefits of fluoridation in preventing tooth decay and improving overall health outcomes.
The Proven Benefits of Fluoridation
Fluoride has been a cornerstone of dental public health for decades. Recognized by the Centers for Disease Control and Prevention (CDC) as one of the greatest public health achievements of the 20th century, fluoridation has played a crucial role in reducing cavities and improving oral health. Studies consistently show that communities with fluoridated water experience 25% fewer cavities in children and adults compared to non-fluoridated areas. The American Dental Association (ADA) and the World Health Organization (WHO) both endorse water fluoridation as a safe and cost-effective method of cavity prevention. In fact, in communities that previously had fluoride and it was then removed these benefits become abundantly clear.
A striking historical precedent comes from Juneau, Alaska. In 2007, the city decided to remove fluoride from its public water supply after persistent pressure from fluoride skeptics. The results were both swift and troubling. A 2018 study published in BMC Oral Health found that, within just seven years, the rate of cavities among children had skyrocketed. Dental professionals reported a significant increase in tooth decay, with many children requiring more extensive—and expensive—dental treatments. The cost burden shifted from an inexpensive public health measure to families and healthcare systems dealing with preventable dental diseases. Juneau’s experience serves as a cautionary tale of what can happen when fluoride is removed from a community’s water supply.
Impact on Low-Income and Rural Communities
The removal of fluoride from Utah’s water supply will likely have the greatest impact on low-income and rural communities. Fluoridated water serves as a fundamental preventive measure, particularly for individuals who may lack access to regular dental care. Without it, we risk exacerbating oral health disparities, leading to increased cavities, higher treatment costs, and broader health complications. Historically, communities that lack fluoridation see higher rates of emergency room visits for preventable dental issues, further straining healthcare resources.
While it’s essential to engage in open dialogue about public health interventions and respect individual perspectives, decisions should be guided by robust scientific evidence. Utah’s ban sets a dangerous precedent that could lead other states to reconsider their own fluoridation policies, despite decades of data supporting its effectiveness. If history is any indicator, communities that remove fluoride often see the negative consequences firsthand and later reverse course—but at a high cost to public health.
The Role of Dental Professionals and Public Advocacy
As dental professionals in Boston, we have a responsibility to advocate for evidence-based policies that protect public health. Public education is key to countering misinformation and ensuring that decisions are made with the well-being of entire communities in mind. It is imperative that policymakers consider not only the loudest voices in these debates but also the overwhelming scientific consensus that supports water fluoridation.
The Utah fluoride ban is a step backward, ignoring both historical precedent and modern science. While we must continue to respect different viewpoints, the consequences of this decision—particularly for vulnerable populations—could be severe. Hopefully, Utah and other states considering similar measures will take a closer look at history and the undeniable benefits of fluoride before more communities experience preventable oral health crises.
