Most North Carolina households that are hooked up to community water systems have fluoride in their drinking water.
Data from the Centers for Disease Control and Prevention compiled by the United Health Foundation shows that in 2022 roughly 88% of the North Carolina population was served by fluoridated community water systems.
Community water fluoridation systems have been widely praised as one of the hallmark public health achievements of the 20th century, helping to tamp down tooth decay in children and adults. Nonetheless, there has been debate in some parts of the state about whether to continue with community fluoridation.
On Feb. 17, Lincoln County adopted a resolution to pass along to the state Department of Health and Human Services letting officials there know that they were abandoning the possibility of a community water fluoridation program.
The actions came the same week that Robert F. Kennedy Jr., a longtime fluoridation skeptic, met with the staff of the U.S. Department of Health and Human Services as the new secretary under President Donald Trump.
Kennedy’s Feb. 13 confirmation came after a series of contentious hearings in which senators questioned him about some of his controversial stands on vaccines, science and public health measures.
Study of studies
During one hearing in the U.S. Senate, Kennedy briefly referenced a study published last month in JAMA Pediatrics that some have held up to support theories that fluoride exposure can have a detrimental impact on the cognitive function of children. Community fluoridation advocates point out, though, that study looked at countries with much higher levels of fluoride than is used in water treatment in the United States.
Kennedy tried to talk about the research when responding to a question from North Carolina Republican Sen. Thom Tillis about whether he was a “conspiracy theorist.”
“That is a pejorative, senator, that is applied to me mainly to keep me from asking difficult questions of powerful interests,” Kennedy responded while listing a number of studies that he thought had proven some of those so-called conspiracies to be accurate over time.
But when Kennedy brought up the JAMA Pediatrics article, Tillis quickly cut him off and moved on to other topics.
The fluoride study that prompted the exchange between Kennedy and Tillis was produced by researchers at the North Carolina-based National Institutes of Environmental Health Sciences, who conducted an analysis of past studies on the issue — none of which was conducted in the United States.
The researchers found an inverse relationship between exposure levels to fluoride and children’s IQ scores in the countries studied — as fluoridation levels rose, IQ dipped.
Of the 74 studies reviewed, 52 were rated to have a “high risk of bias” with only 22 rated as a “low risk of bias.” Despite the many caveats throughout the study, critics of community water fluoridation systems in the United States have gravitated to the findings to support their arguments.
Advocates of fluoride in drinking water are just as quick to point out that the studies looked at higher fluoridation levels than those used in U.S. water systems, while also questioning the rigor of the research.
Those advocates continue to laud water fluoridation as one of the greatest public health achievements of the last century — and one of the most effective and easily accessible ways to lower tooth decay in children and adults. The Centers for Disease Control and Prevention, one of the agencies that now falls under Kennedy’s purview, has described putting controlled amounts of fluoride in water systems as the “most cost-effective method of delivering fluoride to all members of the community regardless of age, educational attainment, or income level.”
“Analyses have also shown that water fluoridation provides additional benefits across the lifespan beyond what is gained from using other fluoride-containing products,” the CDC scientific statement on community water fluoridation adds.
Kennedy reignited the debate about fluoride several months before his confirmation when he posted on X that fluoride is “an industrial waste associated with arthritis, bone fractures, bone cancer, IQ loss, neurodevelopmental disorders, and thyroid disease.”
“We’ve been doing it for a very long time, and there does not appear to be any of these negative effects,” Steve Cline, vice president of the North Carolina Oral Health Collaborative, told NC Health News in a recent interview. “But there is evidence of the benefits.”
Assessing the impact
Lincoln County’s choice to strike fluoride from its water system occurred as similar debates have gone on nationally and locally.
The board of commissioners started their discussion about fluoride late last year and early this year as they realized they needed costly repairs to their water system.
Lincoln County’s fluoride system failed in 2018 because of problems with a tank structure at the plant. The system had been replaced in 2014 with plant upgrades, but it wasn’t until 2022 that the public utilities engineering team recognized the need to either replace the tank or discontinue fluoridation, according to a slide presentation provided to NC Health News.
In December, Andrew Bryant, the Lincoln County development services director, presented the commissioners with a proposal for fixing the system that ranged in cost from $1 million to $1.25 million.
The high price tag was one issue that troubled the commissioners. They also questioned whether fluoride was still needed in the community water system because of its widespread availability in toothpaste, gels and other oral health products.
At the close of the December meeting, the elected officials decided to think about the topic for the next month. Then, on Jan. 6, despite a recommendation from the county board of health to reintroduce fluoride into the water supply, the commissioners voted unanimously “to permanently stop injecting fluoride into the county water system and not seek to restart the process,” according to the meeting minutes.
On Monday, the commissioners adopted the resolution that further elaborates on their reasons. Community members “expressed both support for the introduction of fluoride for dental health and concerns regarding potential adverse health effects associated with fluoride consumption,” according to the resolution that will be sent to the state Department of Health and Human Services oral health division.
The resolution adds “the cessation of water fluoridation may result in significant cost savings for the community by eliminating the purchase, transport, storage, and regulation of fluoride chemicals.”
Lincoln becomes the second North Carolina county to remove fluoride from its water system. Last year, Union County commissioners voted for a ban on fluoride in its community water system after a group that called themselves the “fluoride fighters” urged the elected officials to take action.
Stanley County commissioners last year also debated fluoridation but chose not to act.
What Juneau knows
Brian Helms, vice chairman of the Union County board of commissions, gave NC Health News similar reasons for his support for the Union County ban. After listening to people from a variety of vantages, Helms said he was compelled to give people a choice about what they wanted in their water.
“Fluoride is the one and only chemical that we add to our drinking water that’s designed to treat the person and not the water,” Helms said. “With that in mind, there is emerging science to show that fluoride that you’re getting in your water is not the fluoride you get at your dentist’s office or in a rinse. You’re actually ingesting it.”
But other communities, such as Juneau, Alaska, have experienced the results of eliminating widespread fluoridation. The Alaska state capitol was an early adopter of keeping fluoride out of its community water system. The city stopped fluoridating its water in 2007.
Jennifer Meyer, an assistant professor at the University of Alaska Anchorage Division of Population Health Sciences, did a study several years ago by examining Medicaid claims for about 2,000 children younger than 6 in Juneau.
She measured data from two different years — one set from when the water was fluoridated and the other when it was not.
When the water was fluoridated, she found, the younger children in Juneau had an average of 1 ½ procedures a year related to cavities. After the fluoridation was discontinued, those procedures went up to 2 ½ per year.
Her conclusion?
Optimal community water fluoridation exposure not only helps prevent dental decay, but it provides fiscal estimates that “help decision-makers advance oral health, prevent dental caries, and promote equity in oral health outcomes.”
Those findings did little to sway change in Juneau.
The Juneau mayor told the Associated Press in 2019 after widespread publicity about the research that the city was unlikely to change, despite the study findings.
The matter had been put to a city-wide vote in 2007 and the majority went with non-fluoridation, the mayor said.
This article first appeared on North Carolina Health News and is republished here under a Creative Commons license.
