Alexandria Treats Water with Fluoride. What Are the Pros and Cons?

ALEXANDRIA, VA-Drinking water that is used by residents in the City of Alexandria has been fortified with fluoride. That is the practice in thousands of cities, towns, and municipalities in the United States, including 96% in the Commonwealth. But Robert F. Kennedy Jr., the current nominee to lead the U.S. Department of Health and Human Services, wants to end the practice of adding fluoride to public water supplies, calling it “industrial waste” that has been linked to a variety of negative health outcomes. This raises the question: Is the practice of adding fluoride to public water good or bad?
The Details
Fluoride is a mineral that occurs naturally in soil, water, and rocks. In the first quarter of the last century, several health professionals concluded that low levels of fluoride in drinking water could prevent cavities.
According to the Centers for Disease Control, the first community in the United States to add fluoride to its drinking water was Grand Rapids, Michigan, in 1945. The CDC reports that in 2022, more than 209 million people, or 72.3% of the U.S. population served by public water supplies, had access to water with fluoride.
Beginning in 2015, the Department of Health and Human Services recommended an optimum fluoride concentration of 0.7 milligrams per liter, which is equal to approximately three drops of water in a 55-gallon barrel, to decrease the occurrence and severity of tooth decay and reduce the risk of dental fluorosis (a condition that affects the appearance of teeth, causing discoloration or spots). This value replaced the previous recommended range of 0.7-1.2 milligrams per liter, issued in 1962, to account for fluoride that is available from other sources including toothpaste and mouthwash.
The Virginia Department of Health regulates more than 1,000 community waterworks in Virginia. For the community waterworks that add fluoride, its Office of Drinking Water reviews plans and specifications for fluoride feed systems and requires regular reports about the fluoride concentration in water that consumers receive.
One of those communities is the City of Alexandria, where Virginia American Water supplies an average of 15.5 million gallons per day to approximately 27,600 residential and business customers. While Virginia American Water owns and operates the distribution system, the company purchases, from Fairfax Water, water to which fluoride has already been added.
In a written statement to The Zebra, American Water stated that it
applies fluoride as mandated or requested by state or local governments. In some instances, we have acquired systems and do not have the history or know why and when the operation started to include fluoride in the water treatment process. State and local governments, including city councils and water authorities, decide whether to implement water fluoridation. Some states have laws that require water systems of a certain size to provide fluoridated water. Public health officials, policymakers, scientists, and community health advocates work together to make this decision.
The Virginia Department of Health reports that no community waterworks in Virginia that are currently permitted has reported fluoride levels that are close to or above the U.S. Environmental Protection Agency’s maximum level for drinking water.
The Argument For Adding Fluoride
One of the most compelling arguments for adding fluoride to drinking water is its ability to prevent tooth decay. Fluoride strengthens tooth enamel – the outer layer of teeth – making it more resistant to acids and bacteria that can cause cavities. According to the CDC, water fluoridation has been shown to reduce tooth decay by 25% in both children and adults.
The CDC explains that, unlike other dental treatments that may be limited to those who can afford them, fluoride in drinking water protects everyone – regardless of age, income, or access to dental services. This makes it an affordable method of promoting oral health, especially in underprivileged or rural areas where dental care may be less accessible. According to the CDC, communities save approximately $38 in dental treatment costs for every dollar spent on water fluoridation.
The Argument Against Adding Fluoride
One of the most common concerns when adding fluoride to drinking water is dental fluorosis. This occurs when young children consume too much fluoride during the years when their teeth are developing.
Some environmental advocates argue that the addition of fluoride to drinking water can have unintended consequences for ecosystems. Fluoride that is not absorbed by the body may end up in wastewater and eventually enter rivers, lakes, and other natural habitats. Over time, this could affect aquatic life, particularly in areas where fluoride concentrations are higher.
Finally, when fluoride is added to public water supplies, individuals may be unknowingly consuming it, even if they do not wish to do so. Critics argue that this undermines personal choice, as people should have the right to decide what substances they ingest.
The Scientific Debate
From the inception of adding fluoride to drinking water, there have been debates about its merits. An October 1944 editorial published in the Journal of the American Dental Association warned against rushing to fluoridate drinking water. Two months later, the journal walked back its criticism, but reiterated the need for more research before fluoridation could be considered an acceptable public health intervention.
An August 2024 report from the National Toxicology Program, part of the Department of Health and Human Services, concluded, after reviewing studies conducted in Canada, China, India, Iran, Pakistan, and Mexico, that drinking water containing more than 1.5 milligrams of fluoride per liter is consistently associated with lower IQs in kids. The Florida Surgeon General thereafter recommended against adding fluoride to community water supplies, citing those studies.
That study was also cited by a California federal judge, who ruled in September 2024 that “community water fluoridation at 0.7 mg/L presents an unreasonable risk of injury to health” and that the Environmental Protection Agency was obligated to take steps to lower the risk. Following that ruling, however, multiple health organizations, including the American Dental Association and American Academy of Pediatrics, reaffirmed their position that water fluoridation is a safe practice that improves oral health.
Whether water fluoridation is necessary to achieve these stated benefits was called into question by an October 2024 review of 157 studies suggesting that, given the widespread addition of fluoride to toothpaste since 1975, community water fluoridation may now have only modest benefits in reducing tooth decay and increasing cavity-free children, compared to the effects seen in earlier studies. The same study concluded there is not enough evidence to determine the impact of stopping fluoridation or its effect on socioeconomic disparities in dental health.
Conclusion
The nomination of Robert F. Kennedy Jr. to lead the Department of Health and Human Services is sure to continue the increasing debate over water fluoridation.
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