A new study published in the JAMA Health Forum projects significant increases in tooth decay and healthcare costs if fluoride is removed from U.S. public water systems, a move currently under consideration in several states and supported by federal proposals from Health and Human Services Secretary Robert F. Kennedy Jr.
Kennedy, as Secretary of the Department of Health and Human Services (HHS), has pledged to remove fluoride from the U.S. water supply. If enacted, Kennedy’s proposal would represent a significant shift in public health policy, ending a practice that began in 1945 and is credited with major reductions in tooth decay across the population.
Kennedy has no medical training or expertise, no legitimate background in health care or public health.
Researchers at Harvard Medical School conducted a cost-effectiveness analysis using data from the National Health and Nutrition Examination Survey (NHANES) to simulate what would happen if public water fluoridation ceased nationwide. Their model predicts:
- A 7.5 percentage point increase in dental caries (tooth decay) prevalence among U.S. children within five years.
- An estimated 25.4 million additional decayed teeth and a loss of 2.9 million quality-adjusted life-years (QALYs).
- An added $9.8 billion in dental care costs over five years, disproportionately impacting children who are publicly insured or uninsured.
- Over a 10-year period, these effects would roughly double, with costs rising to $19.4 billion.
The study also found that optimizing fluoride levels in communities currently receiving less-than-optimal fluoridation would reduce tooth decay and save billions in healthcare costs.
Across the U.S., water fluoridation has come under increased scrutiny due to concerns about potential neurotoxicity at high exposure levels. Several states and municipalities are considering or have enacted measures to reduce or eliminate fluoride in public water supplies.
Florida and Utah have recently banned community water fluoridation. While long-term state-specific data are still emerging, the national model projects that if all states followed suit, one in three children would develop an additional decayed tooth within five years.
In Juneau, Alaska, after fluoride was removed from the water supply, children enrolled in Medicaid experienced a 47% increase in cavity-related treatment costs within nine years. Calgary, Canada, saw a 78% increase in the use of general anesthesia for young children with severe dental decay after fluoridation was stopped. This spike in dental disease prompted the city to reinstate water fluoridation in 2025.
