No fluoridation for Floridians

Gov. Ron DeSantis this week said he would sign the Florida Farm Bill, which includes a provision banning the addition of fluoride to public water supplies. DeSantis claimed fluoride is a “medication” being forced on the public.

The decision means Florida will become only the second state in the nation to prohibit fluoridation. While the ban does not specify the chemical fluoride, it prohibits public authorities from adding anything to the water supply. The law will take effect on July 1.

DeSantis made his decision even though dental decay in Florida children is among the highest in the nation and despite opposition from most major state and U.S. dental health professional and scientific groups. In a statement, the leader of the Florida Dental Association condemned the decision, arguing that local governments should maintain the right to provide fluoridated water to their communities.

“The Florida Dental Association strongly reinforces that fluoridation is a naturally occurring mineral, not a medication, that is already present in the water in many parts of the country, including Florida,” said Florida Dental Association President Jeff Ottley. “Water fluoridation has been researched for more than 80 years, and overwhelming, credible scientific evidence consistently indicates that fluoridation of community water supplies is safe and effective at preventing and repairing tooth decay.”

Numerous studies covering eight decades of scientific research show the addition of fluoride strengthens tooth enamel and helps reduce tooth decay by 25%, according to the American Dental Association.

The law will impact about 100 municipal water providers in Florida that currently add fluoride to water. The city of Fernandina Beach does not add fluoride to water.

In remarks made at a May 6 news conference, DeSantis defended his decision, saying fluoridation is “forced medication when they’re jamming fluoride into your water supply.”

The bill’s passage was expected. Last November, state Surgeon General Joseph A. Ladapo released a statement recommending again community fluoridation. Ladapo argued that fluoride is readily available from other sources, including toothpaste and mouthwashes. Ladapo stated his belief that fluoride exposure can reduce intelligence in children and contribute to attention deficit disorder and neurobehavioral issues in children. The nation’s Health and Human Services chief, Robert F. Kennedy Jr., has also expressed support for halting water fluoridation programs nationwide.

“It is clear more research is necessary to address safety and efficacy concerns regarding community water fluoridation,” Ladapo said. “The previously considered benefit of community water fluoridation does not outweigh the current known risks, especially for special populations like pregnant women and children.” 

Ladapo said he supports the operation and expansion of school-based and county public health and preventive dental services.

In a statement released in November, the Florida Dental Association said Ladapo was wrong.

“The recent recommendation by the Florida’s Surgeon General to cease community water fluoridation due to the neuropsychiatric risk associated with fluoride exposure is based on flawed and unscientific reports,” Florida Dental Association leaders said.

Tooth decay among U.S. children, however, is documentable. Nationwide, about 11% of children ages 2 to 5 have untreated tooth decay, according to the 2024 Oral Health Surveillance Report from the U.S. Centers for Disease Control and Prevention. Nearly 18% of children ages 6 to 8 had untreated tooth decay.

According to statistics from the Florida Department of Health, more than 25% of third grade children in Florida have untreated dental decay, which is the fourth worst in the nation.

Only about 43% of Forida children received any dental service in 2020, much lower than the national average (52.3%), according to according to the American Children’s Campaign, a nonprofit group based in Tallahassee that advocates for child health. Poor children, children of color and children for whom English is not their primary language encounter the most barriers to dental care.

Florida also has one of the highest rates in the country for providing insufficient dental care. Sixty-five out of 67 Florida counties are designated as having too few dental providers, according to the American Dental Association.

“Eliminating a proven public health strategy to reduce dental disease in a state that has access-to-care issues is very short-sighted,” said Brett Kessler, president of the American Dental Association in a statement issued last November after Ladapo announced his opposition to fluoridation.

According to the Florida Dental Association, fluoride is present naturally in water and varies in concentration depending on the minerals in the rocks and ore found in each community. Municipal fluoridation programs adjust the amount of fluoride in the water to a level that is recommended for optimal dental health — 0.7 milligrams per liter. Fluoride concentrations of about 1.5 mg/L can be harmful.

According to the 2024 City of Fernandina Beach Annual Water Quality Report, naturally occurring fluoride in the city water supply was most recently measured at 0.59 mg/L.

People who reside in areas where the public water supply is not fluoridated should follow the following recommendations, according to the CDC:

For Adults

• See a dentist at least once a year.
• Brush your teeth twice a day with fluoride toothpaste.
• Floss daily.

For Babies

• Wipe gums twice a day with a soft, clean cloth in the morning after the first feeding and right before bed to wipe away bacteria and sugars that can cause cavities.
• When teeth come in, start brushing twice a day with a soft, small-bristled toothbrush and plain water.
• Visit the dentist by your baby's first birthday to spot signs of problems early.
• Talk to your dentist or doctor about putting fluoride varnish on your child's teeth as soon as the first tooth appears.

For Children

• Brush their teeth twice a day with fluoride toothpaste.
• Help your child brush their teeth until they have good brushing skills. If your child is younger than 6, watch them brush. Make sure they use a pea-sized amount of toothpaste and always spit it out rather than swallow.
• Ask your child's dentist to apply dental sealants or fluoride varnish when appropriate.

For children younger than 2, consult first with your doctor or dentist regarding the use of fluoride toothpaste.