Potential Impact of a Nationwide Fluoride Ban on Children's Dental Health and Healthcare Costs

A recent modeling study highlights significant concerns about the potential consequences of banning fluoride from public water supplies across the United States. Fluoride has been added to public water systems since 1945, playing a crucial role in strengthening tooth enamel and preventing bacterial growth that leads to tooth decay. Researchers from Mass General Brigham developed a microsimulation model to analyze how ending water fluoridation might affect children's oral health and associated costs.

The study, published in JAMA Health Forum, utilized detailed data from over 8,400 children aged 0-19 collected through the National Health and Nutrition Examination Survey (NHANES). The researchers simulated two scenarios: maintaining current fluoride levels and completely removing fluoride from public water sources, over periods of 5 and 10 years.

Results indicated that eliminating fluoride could lead to a 7.5 percentage point increase in decayed teeth, translating to approximately 25.4 million additional teeth affected over five years—about one in three children. While cases of dental fluorosis, caused by excessive fluoride, were expected to decrease slightly, the financial impact would be substantial, with an estimated increase in dental care costs by nearly $10 billion over five years, escalating to over $19 billion after a decade.

Senior author Dr. Lisa Simon explained that fluoride integrates into tooth enamel, making it more resistant to decay, and cited evidence from other regions, like Calgary, where removal of fluoride correlated with increased dental disease. The study focused on children because fluoride’s benefits are most evident during tooth development, and robust data link fluoridation to improved oral health in this group.

Importantly, the researchers noted that current fluoride levels are not associated with adverse neurobehavioral effects, affirming the safety of existing fluoride standards set by agencies such as the EPA and CDC. The findings emphasize the significant public health benefits of water fluoridation, suggesting that discontinuing it could lead to a substantial rise in dental decay and related costs—particularly affecting publicly insured and uninsured children.

Overall, the study underscores that fluoride remains a key component of oral health strategies, providing ongoing benefits at safe exposure levels, and that removing it could negate decades of progress in combating dental diseases.