CHICAGO, May 30, 2025 — The 91射区 (ADA) is aware of a new original investigation in JAMA Health Forum on the projected outcomes for children in the U.S. if fluoride is removed from communities. The predicted repercussions confirm that community water fluoridation is essential to prevent disease in this country.
“This report once again validates the financial and health consequences of discontinuing water fluoridation programs,” said Brett Kessler, D.D.S., president of the 91射区. “The simulation model of oral health outcomes again shows the negative health outcomes if we remove fluoride from water in this country, particularly without any counter measures in place to prevent and treat oral diseases. The health and financial impacts will be hardest felt by Medicaid beneficiaries, including children and the most vulnerable Americans who often cannot afford routine oral care.”
Based on the data used to estimate changes in tooth decay over time, the study shows that if community water fluoridation is removed, we should expect to see a 7.5% increase in dental cavities that will cost $9.8 billion dollars over five years if the most conservative estimates are used. The model used clinical examination data from the National Health and Nutritional Examination Survey (NHANES) of over 8,400 children ages 0-19 to estimate an increase in dental caries that would occur under different fluoridation conditions. This analysis demonstrates the substantial ongoing benefits of water fluoridation at the currently recommended levels in the US.
“This is a huge cost for our country and it’s all avoidable. There is no better replacement for the time-tested, doctor trusted use of fluoride in community water programs,” said Dr. Kessler. “No amount of political rhetoric or misinformation will change that good oral health depends on proper nutrition, oral hygiene and optimally fluoridated water, or fluoride supplements if community water programs lack fluoride.”
Eighty years of community water fluoridation at optimal levels has proven to be safe and effective at reducing tooth decay to improve oral health, especially for those who lack health care access. The removal of fluoride, along with currently proposed cost-sharing burdens in Medicaid for dental services, will cause vulnerable individuals to delay care and suffer more severe and costly infections as they will further lack access to preventive dental interventions. Research has confirmed that treatment costs and surgical interventions are associated with an individual’s access to community water fluoridation. For example, in Juneau, Alaska, Medicaid enrolled children experienced an average increase in cavity related treatment costs of 47% within nine years of discontinuing fluoride in the water. This new research in JAMA Health Forum further demonstrates the consequences of bad public health decisions and only further establishes what the shocking personal and financial costs will be for the future of this country.
“Cavities are an infectious disease, and we know what causes them and how to prevent them,” said Dr. Kessler. “Dental disease is one of the most common chronic diseases, five times more common than asthma. It’s time we stopped debating irresponsible and misinformed actions like what is happening in states like Florida and Utah and recognize the serious consequences if we discontinue fluoride in water programs or in dental products.”
Some 100 million Americans do not get to see a dentist each year. Even though regular oral examinations and good oral hygiene can prevent most dental disease, it does not replace the positive effects of fluoride in water.
The ADA follows research on the best ways to advance public health and welcomes research upheld with scientific rigor and statistically significant, evidence-based data to advance oral health care policy. To date, the data continually shows that when fluoride is discontinued, disease also increases.
For more information on community water fluoridation and ADA advocacy, visit ADA.org/fluoride.