Utah becomes the first state to ban fluoride in public water

Utah has become the first state to ban adding fluoride to public water.

The law was signed Thursday by Republican Gov. Spencer Cox, among 77 other bills. The ban, which still allows pharmacists to prescribe fluoride, will start on May 7.

Cox had previously announced he would sign the bill despite saying he did not feel strongly about the issue. He said he had grown up and raised his children in an area without fluoride in the water. Around 44 percent of Utahans who were provided with public drinking water consumed fluoridated water in 2022, according to the Centers for Disease Control and Prevention.

“We’ve ran this natural experiment … you think you would see drastically different outcomes with half the state not getting it, and half the state getting it. I’ve talked to a lot of dentists, we haven’t seen that. It’s got to be a really high bar for me, if we are going to require people to be medicated by their government," Cox told ABC4.

“And, what they also did was make it easier for families to get fluoride. If that’s what you want to do, you can get it,” he added.

Opponents warn Utah’s ban will disproportionately affect low-income residents, who may rely on public drinking water having fluoride as their only source of preventative dental care.

There is strong evidence that fluoride works to protect people’s teeth, replacing minerals lost due to wear and tear. More than 200 million people in the U.S. receive fluoridated water through community water systems. The American Dental Association said studies prove fluoridation reduces dental decay by at least 25 percent in children and adults. The association sent a letter asking Cox to veto the bill.

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Experts also say the benefits outweigh any risks.

Fluoride intake has both beneficial impacts and risks, according to the World Health Organization. It can reduce tooth decay and cavities, and it can cause bone disease after lengthy exposure to high amounts. It is estimated that excessive fluoride concentrations in drinking water have caused tens of millions of dental and skeletal fluorosis cases globally. Research on other impacts, such as bone fractures, is divided.

The National Toxicology Program previously determined with “moderate confidence” that there is a link between higher levels of fluoride exposure and lower IQ in children. Other studies have found no link between fluoride and IQ – although some Americans are exposed to higher than recommended levels because of natural fluoride contamination.

“There is still no evidence that community water fluoridation, with the fluoride levels used in the United States, is associated with any adverse health effects,” Dr. Scott Tomar, a public health dentist and oral epidemiologist at the University of Illinois Chicago College of Dentistry, told The New York Times in February.

Utah’s move comes amid renewed scrutiny of the mineral, which has been added to U.S. drinking water for decades. Nearly all water contains some naturally occurring fluoride, but at levels too low to prevent the holes in teeth caused by bacteria.

Newly-appointed Health and Human Services Secretary Robert F. Kennedy, Jr., shone a light on the issue, saying in November that the Trump administration would “advise all U.S. water systems to remove fluoride from public water” because of potential health risks.

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Anti-fluoridation bills have also been introduced in three other states: North Dakota, Tennessee and Montana.

According to the Fluoride Action Network, 37 states give local governments and residents authority over fluoridation decisions, and 13 states, Puerto Rico and the District of Columbia, have laws to mandate statewide fluoridation. Some communities have rejected it, the group noted.

“We’ve got tried and true evidence of the safety and efficacy of this public health initiative,” American Dental Association President Brad Kessler told The Associated Press earlier this month.

He said cavities could start emerging in children within months or years of Utah stopping fluoridation. Utah children consume more sugary drinks than the national average. Sugar causes cavities.

“The science proves that it is effective at reducing cavities with little to no risk of other problems,” he said.

With reporting from The Associated Press