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Reevaluating Water Fluoridation: What You Need to Know
In recent years, water fluoridation has moved from a routine public health measure to the center of a complex and growing debate.
Once widely accepted as a safe and effective way to prevent tooth decay, it's now being reevaluated by researchers, medical professionals, and concerned citizens.
One voice leading this shift is Dr. Michael Greger, who shared his change of perspective in the webinar, "Why I Changed My Mind on Water Fluoridation."
His updated stance is based on emerging science that calls into question many long-standing assumptions.
This article dives into those evolving insights, adds supporting perspectives from other experts in public health and environmental science, and breaks down what this means for families across Sacramento and beyond.
In 'Why I Changed My Mind on Water Fluoridation,' Dr. Greger dives into the evolving understanding and controversies surrounding fluoride in our water supply, illuminating critical gaps that sparked our comprehensive analysis.
Understanding the Basics: What Is Water Fluoridation?
Water fluoridation is the process of adding fluoride—a naturally occurring mineral—to public water systems to reduce tooth decay.
It began in the U.S. in the 1940s after studies showed that communities with naturally fluoridated water had fewer cavities.
Over time, cities began adding fluoride to municipal supplies in an effort to improve dental health for everyone, regardless of income or access to care.
The Centers for Disease Control and Prevention (CDC) once named it one of the top ten public health achievements of the 20th century.
However, it’s important to note that fluoride is not a vitamin or essential nutrient. It's a chemical additive, and as more research has emerged—especially from areas with naturally high levels of fluoride in water—so have questions about whether it's still the best choice for everyone.
“When it comes to brain development in children, even small exposures to neurotoxic chemicals can have lifelong effects. Fluoride may belong on that list.”
— Dr. Philippe Grandjean, Physician and Environmental Health Researcher, Harvard
The Evidence: Pros and Cons of Fluoridation
There’s no doubt that fluoride can strengthen tooth enamel and help prevent cavities. Studies have shown that in fluoridated communities, children tend to have fewer cavities than in areas without added fluoride.
According to the World Health Organization, early studies linked fluoridated water with up to a 35% reduction in dental caries (tooth decay) in children.
But over the years, other sources of fluoride—like toothpaste, mouthwash, and even processed foods made with fluoridated water—have added to our overall exposure.
Many experts now question whether we still need to drink fluoride to get the dental benefits.
“We now know that fluoride primarily works on the surface of teeth, not from inside the body. The benefits come from brushing, not from swallowing.”
— Dr. Hardy Limeback, Former Head of Preventive Dentistry, University of Toronto
In other words, topical fluoride (like what's found in toothpaste) may offer similar or even better protection, without the potential downsides of systemic exposure.
Health Risks: The Associated Concerns
One of the most visible side effects of too much fluoride is dental fluorosis—a condition that causes white spots, streaks, or even brown discoloration on children’s teeth.
This occurs when kids get too much fluoride while their permanent teeth are still forming, typically under age 8. According to the CDC, about 25% of American children now show signs of fluorosis.
More troubling, though, are the neurological concerns raised by recent research.
A growing number of peer-reviewed studies suggest that elevated fluoride levels during pregnancy may be linked to lower IQ scores in children.
One of the largest studies, published in 2019 in JAMA Pediatrics, examined over 500 mother-child pairs and found a significant drop in IQ for boys born to mothers with higher fluoride levels during pregnancy.
“The effects we’re seeing on the developing brain are similar in size to what we see with lead exposure. That should raise serious concern.”
— Dr. Bruce Lanphear, Environmental Toxins Researcher and Study Co-Author
In 2022, the National Toxicology Program (NTP) also weighed in, classifying fluoride as a “presumed developmental neurotoxin.”
This classification now places it in the same risk category as lead and mercury—a dramatic shift from previous public health messaging.
Changing Perspectives: Seismic Shifts in Thought
As new data continues to emerge, even longtime advocates of fluoridation are beginning to reconsider. Dr. Michael Greger, well-known for his evidence-based approach to public health, has publicly reversed his position.
Citing recent neurotoxicity research and updated recommendations, he argues that fluoride’s risks now outweigh its benefits—especially for vulnerable populations like pregnant women and young children.
And he’s not alone.
“We should focus on methods that deliver fluoride where it’s needed—on the surface of the tooth—not to the whole body.”
— Dr. Paul Connett, Founder, Fluoride Action Network
Several countries—including Sweden, the Netherlands, and Japan—have already banned or discontinued water fluoridation due to ethical and health concerns.
Even in the U.S., more cities and counties are revisiting their policies. In 2023, the city of San Jose, California, voted to delay fluoridation expansion due to community pressure and concerns about safety.
What’s Next for Fluoridation? Future Predictions and Considerations
As the science changes, public policy is being forced to catch up. The U.S. Department of Health and Human
Services has already lowered its recommended level of fluoride in drinking water from 1.2 parts per million to 0.7, acknowledging that overexposure is more common than previously believed.
Organizations like the American Academy of Pediatrics still support water fluoridation but emphasize the need for regular review of the latest science.
At the same time, grassroots efforts to reduce or eliminate fluoridation are gaining traction in communities nationwide.
“When public health measures lose their trust base, it’s important to re-engage people in the conversation and update our practices when necessary.”
— Dr. Leonardo Trasande, NYU Pediatrician and Environmental Health Specialist
Alternative strategies are being explored—like expanding access to fluoride toothpaste, offering fluoride varnish treatments in schools, and improving dental care education.
These options allow people to make informed decisions about fluoride exposure on an individual level.
Get Involved: What Can You Do?
If you're concerned about fluoride in your water, here are a few steps to stay informed and proactive:
Check your local water report – Sacramento residents can usually find water quality reports on city or utility websites. Look for “fluoride” levels listed in parts per million.
Use a water filter – Certain water filters, like reverse osmosis systems, can reduce fluoride levels. Look for NSF-certified options.
Brush with fluoride toothpaste – This gives you cavity protection without the need for ingestion.
Get involved locally – Attend city council meetings or contact public health officials to voice your concerns or ask questions.
Final Thoughts: A Call for Ongoing Dialogue
Water fluoridation has undoubtedly improved public dental health over the decades, especially when dental care wasn’t accessible to all.
But times have changed. We now live in a world with many more fluoride sources—and far more scientific research on the long-term effects of exposure.
This doesn’t mean fluoride is “bad,” but it does mean it’s worth rethinking how we use it. Like all public health decisions, fluoridation must be continually re-evaluated in light of the best available evidence.
By staying educated and engaged, we can make choices that prioritize our health, our children's development, and our community’s well-being—without simply accepting the status quo.
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