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Quick Bites

Across Washington, activists are fighting fluoridation in public water systems. As a result, more state residents are at risk of losing the benefits of a proven public oral health program.

The American Dental Association (ADA) recognizes the use of fluoride and community water fluoridation as safe and effective in preventing tooth decay for both children and adults, noting that studies have shown that the practice prevents at least 25% of tooth decay in children and adults.

ADA goes even further, declaring that  experience has shown that “fluoridation of community water supplies is the single most effective public health measure to prevent tooth decay.” The non-partisan Centers for Disease Control (CDC) concurs, calling water fluoridation “one of the 10 great public health achievements of the 20th century,” comparable to vaccinations and infectious disease control.

The first public water fluoridation began more than a century ago in Colorado Springs. After testing, researchers identified an effective fluoride level that protects teeth without side effects. Water fluoridation has since become common in the United States after World War II. In 2015, U.S. health officials lowered the recommended amount of fluoride in water systems to 0.7 milligrams per liter, recognizing that a higher level was not needed, given other sources of fluoride such as toothpaste.

Growing Controversy

Why has community water fluoridation re-emerged as a topic of controversy, and why are battles over the practice on the rise?

To be clear, there have always been small pockets of resistance who reject the scientific evidence in favor of water fluoridation. But those pockets have grown larger and more vocal as some federal and state public officials have publicly criticized the practice.

In 2025, both Utah and Florida enacted statewide bans on community water fluoridation partially based on arguments “against forced medication” and “prioritizing individual choice.” Nationally, federal agencies including the FDA and EPA also began reviewing existing fluoridation policy and announced an intent to take enforcement action against some manufacturers that sell fluoride supplements marketed to children unless they are older than three and at high risk for tooth decay.

What the Science Actually Says

Fluoride critics point to some studies that appear to present evidence of problems associated with excessive exposure to fluoride. But these studies have typically focused on exposure levels far in excess of the 0.7 milligram per liter concentration that is the CDC’s recommended target for public water fluoridation.

The peer-reviewed Journal of the American Medical Association looked at 74 articles on studies on the links between IQ points and fluoride. Authors of the JAMA article determined that there is a high risk of scientific bias in 52 of those studies and a low risk of bias in 22. Forty-five of the articles originated from China.

The JAMA review found that fluoride levels above 1.5 milligrams per liter — over twice the recommended amount—may be linked to reduced intelligence.

According to Dr. Chris Dorow, Immediate Past President of the WSDA, the JAMA study reinforces a centuries-old maxim of science:  namely that the dose of substance, rather than the substance itself, often dictates whether it is toxic.

The ADA points out that fluoride occurs naturally in most water supplies, and community water fluoridation is the controlled adjustment to a level that’s optimum for preventing tooth decay, 0.7 milligrams per liter. At this lower concentration, water fluoridation is analogous to other food supplements that the public takes for granted: iodine in salt, vitamin D in milk, and vitamin C in orange juice.

“These are supplements, not medications,” the Association’s fluoride materials declare. “Simply by drinking water, people can benefit from fluoridation’s cavity protection whether at home, work or school. Water fluoridation is the most cost-effective means of preventing tooth decay for both children and adults in the United States. The cost of a lifetime of water fluoridation for one person is less than the cost of one filling.”

What’s Happening in Our State

Washington already trails the country  in the percentage of the population served by fluoridated water systems. While recent studies have found that nearly three-quarters of the U.S. population is served by optimally fluoridated public water systems, the Washington State Department of Health (DOH) estimates that only 46% of Washington residents get their water from such a system.

Still, recent battles over water fluoridation have been fought in a number of Washington communities, just as they have in other states.

Florida and Utah have already implemented statewide bans on fluoridation of public water systems. Washington’s DOH leaves the issue up to local communities, and a growing number have seen public debates on the issue.

City councils in Pasco in southeast Washington, Lynden near the Canadian border, and Aberdeen in Grays Harbor County all have voted to end the practice. In southwest Washington, officials in Longview and Battle Ground have considered the issue before voting to retain their current fluoridation practices, while the City of Camas dropped the issue after consulting with their local water system operators. Yakima is reportedly pondering the issue.

While there doesn’t appear to be a coordinated campaign behind the ban efforts, the growing number of communities considering eliminating fluoride is troublesome to dental and public health experts.

“These [Washington efforts] are grassroots organizing. But the national narrative is driving it,” said Dorow, who practices in rural Othello. “While the water around Othello is already high in fluorides, other rural communities might not be so fortunate. Patients that have to travel to get dental care can really benefit from the protection that fluoride provides.”

In addition to rural residents, those who stand to benefit the most from the fluoridation of public water systems are Hispanic, Native American and Black children. These groups historically have had more limited access to care and experienced higher rates of tooth decay than their white counterparts. Fluoride can help level the oral health playing field for these children.

Need for Dentist Engagement

That’s just one of the reasons that local dentists should engage to combat the move toward fluoride bans, according to Bracken Killpack, executive director of the Washington State Dental Association.

“Dentists have credibility on public health issues, especially in matters of oral health,” said Killpack. “It’s important that they share timely and factual information about the benefits of fluoridation.”

He noted, for instance, that local reports of the decisions against fluoride bans in southwest Washington credited the local dental community with turning the tide against the proposals.

WSDA member dentists looking to join in the battle to preserve an effective public health measure should consider the following, according to Killpack:

• Talk with your patients. The ADA has materials that can be downloaded and shared with patients to not only explain the benefits of water fluoridation but also counter some of the questionable or false claims made by anti-fluoride activists.
• Engage local elected officials. Get to know your local council members before a fluoride issue comes before them. Invest a couple of hours getting to know them and allowing them to get to know you. These conversations can be a good opportunity to note that you’ve seen fluoride bans proposed elsewhere and why it would be bad if that happened in your community.
• Help educate the public. If activists propose a ban in your community, it’s important that you reach as many people as possible. Consider writing a guest column or a letter to the editor of your local newspaper. Volunteer to speak at local service clubs on the issue.
• Attend public hearings and community meetings. Ultimately, public officials base their decisions on the information that gets presented to them. Even though sitting in a public hearing listening to misperceptions about fluoride may not be high on your list of fun ways to spend an evening, it’s important that they hear from dental professionals.