The Fight Over Fluoride

Summary

The Journal: The Fight Over Fluoride Release Date: April 4, 2025

Introduction

In this episode of The Journal, hosted by Ryan Knutson and featuring reporter Chris Maher, the focus is on one of the most contentious debates in public health: the addition of fluoride to drinking water. For decades, municipalities across the United States have incorporated fluoride into water supplies to enhance oral health. However, recent developments have reignited controversy, prompting communities to reassess the practice.

Historical Context and Benefits of Fluoridation

Fluoride, a mineral naturally present in certain water sources and foods like black tea and fish, has been associated with improved dental health since the early 20th century. The practice of water fluoridation began in 1945 in Grand Rapids, Michigan, after studies revealed that adequate fluoride levels could significantly reduce cavities. By the 1950s, the American Dental Association endorsed fluoridation, leading to its widespread adoption. Dr. Johnny Johnson, a pro-fluoride advocate, emphasized its benefits: “We don't like to see that at all” (12:27), referring to severe dental decay.

Fluoride's role in remineralizing tooth enamel and preventing cavities, especially among lower-income children with limited access to dental care, was lauded as a "miracle defense against cavities" (05:07). The Centers for Disease Control and Prevention (CDC) even recognized water fluoridation as one of the greatest public health achievements of the 20th century (05:48).

Emerging Skepticism and New Research

Despite its long-standing acceptance, fluoride has not been without its critics. Initial skepticism centered around the ethical implications of adding a chemical to public water supplies for health benefits, rather than safety. This view was once considered fringe, even being depicted satirically in the 1964 film Dr. Strangelove (06:05).

However, recent studies have reignited concerns about fluoride's safety. Over the past decade, research has linked higher fluoride exposure to lower IQ levels, Attention Deficit Hyperactivity Disorder (ADHD), and potential harm to infants' neurological development. A pivotal moment came with a report from the National Toxicology Program in August 2024, which stated, “children that had been exposed to fluoride at higher levels had IQ deficits” (07:42).

Recent Developments: Utah's Ban and Federal Rulings

In response to mounting evidence, Utah became the first state to ban local governments from adding fluoride to drinking water (00:59). Following this, a judge mandated that the Environmental Protection Agency (EPA) take regulatory action on fluoride levels, deeming the existing standards as posing an "unreasonable risk" (08:07). This landmark ruling has intensified the national debate, as localities nationwide grapple with the decision to continue or cease fluoridation.

National Debate and Local Actions: The Case of Bartow, Florida

Chris Maher attended a heated town hall meeting in Bartow, Florida, where residents debated the future of fluoride in their water supply (10:31). The meeting, facilitated by Bartow's mayor, featured passionate arguments from both sides. Dr. Johnny Johnson, representing the pro-fluoride stance, presented compelling evidence of severe dental decay in the absence of fluoride: “People die of dental infections that get into their bloodstream septice” (12:27). He argued that removing fluoride would disproportionately affect low-income populations who rely on public water fluoridation for dental health.

Conversely, Dr. Joseph Latapo, Florida’s Surgeon General, advocated against fluoridation, highlighting the availability of alternative dental care products: “There are alternatives, right? There's toothpaste, there's mouthwash. This isn't expensive stuff” (13:53). Latapo underscored the potential health risks, stating, “the benefits of fluoride were outweighed by the risks” (14:11).

Despite the intense debate, the Bartow City Council ultimately decided to continue adding fluoride to the water supply (15:00). This decision reflects the broader national divide, with some communities standing by established public health practices while others move to reevaluate them.

Influential Figures: Robert F. Kennedy Jr.'s Role

The resurgence of the fluoride debate has been amplified by prominent figures like Robert F. Kennedy Jr. Dr. Johnny Johnson noted Kennedy’s significant influence: “He tweeted that the Trump administration would advise all public water systems to get fluoride out of the water” (09:16). Although Kennedy’s nomination to lead the Department of Health and Human Services under President Trump had not yet resulted in policy changes (09:40), his vocal opposition has provided momentum to the anti-fluoride movement.

Perspectives and Arguments

Pro-Fluoride Advocacy: Dr. Johnny Johnson, president of the American Fluoridation Society, passionately defends fluoride's benefits. Presenting graphic images of dental decay, he argues that removing fluoride would lead to severe health consequences, particularly for vulnerable populations. “We don't like to see that at all” (12:27), he stated, emphasizing his commitment to preventing preventable dental disease.

Anti-Fluoride Advocacy: Dr. Joseph Latapo represents the growing concern over fluoride’s safety. He argues that with available alternatives, the potential health risks of fluoridation are not justified. Latapo declared, “The benefits of fluoride were outweighed by the risks” (14:11), calling fluoridation reckless given the new scientific findings.

Industry and Financial Considerations

The debate also touches on the potential financial motivations behind the opposition and support for fluoridation. Chris Maher explored whether the dental industry benefits financially from fluoride in water. He concluded, “No. I mean, you take a town like Bartow or some of these other small communities, they're not spending a ton of money on fluoride or this chemical that creates the fluoride. They're spending maybe $20,000 a year. So it's not a tremendous amount of money” (13:42). Thus, the opposition and support appear to be driven more by health concerns and ethical considerations than by financial incentives.

Current Trends and Future Outlook

As fluoride debates continue across the United States, the anti-fluoride movement appears to be gaining ground. Chris Maher observed, “I think the anti fluoride movement has the upper hand. There seem to be more places... they're voting the fluoride out” (15:49). Pro-fluoride advocates like Dr. Johnson are actively campaigning to counter these trends, but the momentum seems to be shifting toward reevaluating long-held public health practices.

Looking forward, Maher is closely monitoring potential federal guidance from the EPA or the Department of Health and Human Services, which could significantly influence public water systems' policies on fluoridation (15:28).

Conclusion

The fight over fluoride in America's drinking water encapsulates a complex interplay of public health benefits, emerging scientific concerns, local governance, and influential advocacy. As communities like Utah and Bartow navigate their policies, the national debate continues to evolve, shaping the future of a practice that has long been considered a cornerstone of public dental health.

Notable Quotes:

• Chris Maher on Utah’s ban: “Utah's now the first state to ban fluoride in drinking water, pushing past opposition” (01:15).
• Dr. Joseph Latapo on fluoride risks: “The benefits of fluoride were outweighed by the risks” (14:11).
• Dr. Johnny Johnson on dental decay: “People die of dental infections that get into their bloodstream septice” (12:27).

Timestamp Highlights:

• [00:59] Utah becomes the first state to ban fluoride in water.
• [07:14] National Toxicology Program report links high fluoride levels to lower IQ in children.
• [10:31] Detailed account of the Bartow, Florida town hall meeting.
• [15:49] Observation that the anti-fluoride movement is gaining momentum.

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This summary is based on the transcript provided and aims to encapsulate the key discussions, insights, and conclusions presented in the episode without including non-content sections such as advertisements and intros.

Transcript

[Ryan Knudsen]

So, Chris, how are your teeth?

[Chris Maher]

So, you know, I grew up having a number of cavities, actually.

[Ryan Knudsen]

Our colleague Chris Maher has been reporting on one of the biggest debates in teeth, whether or not fluoride should be added to drinking water. For decades, municipalities around the US have been doing this to improve oral health. But recently, fluoride has become more controversial.

[Chris Maher]

I have done a lot of reporting on water, but really, to be honest, fluoride never really hit my radar as an issue until last year.

[Ryan Knudsen]

Over the past year, communities across the country have started to reconsider fluoride.

[Chris Maher]

There's a shift in tone where I think there's just more credence to the position that fluoride may have been a good thing in the past, but it just may not be necessary now. It's really gaining some momentum.

[Ryan Knudsen]

And last week, Utah became the very first state to ban local governments from adding fluoride to water.

[Tim Higgins]

Utah taking a side in the renewed debate over fluoride in drinking water.

[Chris Maher]

Utah's now the first state to ban fluoride in drinking water, pushing past opposition.

[Ryan Knudsen]

From some dentists and health organizations who warn that the move could lead to medical problems. For some people.

[Chris Maher]

It's a pretty historic development. Going forward in Utah, cities are not going to be able to add fluoride to their municipal drinking water.

[Ryan Knudsen]

And Chris says more bans could be coming. The debate over fluoride is a tricky one because both sides say they're just looking out for the public's health, and both sides also say that they have the science to back it up.

[Chris Maher]

A lot of emotions get raised when it comes down to people's health, you know, their children's health. And it can be very emotionally charged.

[Ryan Knudsen]

Sounds like a lot of people are clenching their teeth over this.

[Chris Maher]

Yeah, that's a good metaphor.

[Ryan Knudsen]

Welcome to the Journal, our show about money, business, and power. I'm Ryan knudsen. It's Friday, April 4th. Coming up on the show, the fight over fluoride in America's water.

[Chris Maher]

Foreign.

[Tim Higgins]

I'm Tim Higgins with the Wall Street Journal. We've got this spot to hear directly from the leaders behind the bold name companies we cover every day. Check out bold names from the Wall Street Journal wherever you get your podcasts.

[Ryan Knudsen]

Fluoride is a mineral that occurs naturally in some water sources and can be found in certain foods.

[Chris Maher]

It's found in black tea. It's found in different kinds of fish, shrimp raisins.

[Ryan Knudsen]

Apparently the history of fluoride science in the US dates all the way back to 1901. When a dentist in Colorado Springs started to study what he called Colorado brown.

[Chris Maher]

Stain, initially, what was noticed was that people had brown staining on their teeth, which is now called dental fluorosis. So this is like a cosmetic thing that can happen to your teeth if you have too much fluoride.

[Ryan Knudsen]

The dentist realized that people who had this brown stain from too much fluoride were also less likely to have cavities. Over the next few decades. Other studies backed up those findings. And in 1945, Grand Rapids, Michigan, became the first city in the country to add fluoride to its water supply. Not with so much fluoride that it would cause those brown stains, but with just enough to reduce cavities. Why did people feel like it was needed back then?

[Chris Maher]

Well, dental health was a lot different back then. Just the number of people who had a complete set of teeth in their mouth, you know, was small. It was far more common just to get your teeth pulled. It was far more common for infections and abscesses and serious, you know, health consequences. To follow on from that. In about 1950, at the American Dental association made its first statement supporting fluoridation. And they just kind of started rolling it out to different communities.

[Dr. Johnny Johnson]

In several western towns, children rarely got tooth decay. Why? Their drinking water contained fluoride.

[Ryan Knudsen]

By the 1950s, companies started putting fluoride in toothpaste in mouthwash. Crest introduced its first fluoride toothpaste in 1956.

[Dr. Johnny Johnson]

Now, after years of fluoride research, Procter and Gamble proudly announces triumph over tooth decay for everyone everywhere. As it brings you Crest toothpaste with florestan. It's exclusive.

[Chris Maher]

And, you know, by the 60s and 70s, that was expanding. So people were getting fluoride in their toothpaste, they were getting fluoride treatments, mouthwash, all kinds of other ways to get fluoride.

[Ryan Knudsen]

And early research seemed to say that fluoride, when it was put in water and available broadly, was something like a miracle defense against cavities, especially when it came to lower income children who often didn't have regular access to dental care.

[Chris Maher]

Fluoride helps to remineralize your teeth, so, you know, prevents cavities by basically making the enamel stronger. So, yeah, and I think, you know, there were many studies that said that cavities were reduced by 50% or more, you know, so it was having a huge effect. The CDC said that water fluoridation is one of the greatest, most significant public health achievements of the 20th century.

[Ryan Knudsen]

But along with people who thought it was miraculous, there have always been skeptics.

[Chris Maher]

There have been scientists who have opposed fluoridation from the start in 1945, when it was first put into water intentionally. And some of those people have continued to oppose it for years.

[Ryan Knudsen]

Why were they skeptical?

[Chris Maher]

Fluoride is the only thing that's added to water that is to treat people or, you know, health. It's not to make the water safe for people. It's to actually do something in people's bodies.

[Ryan Knudsen]

But for a long time, those concerns were considered fringe. For instance, in the 1964 movie Dr. Strangelove, this was the sign that one of the main characters had gone off the deep end.

[Dr. Johnny Johnson]

Do you realize that fluoridation is the.

[Chris Maher]

Most monstrously conceived and dangerous communist plot we have ever had to face?

[Ryan Knudsen]

But in recent years, new data has given fluoride skepticism new legitimacy. A number of studies have been published over the last decade about the impact of fluoride on the brain and thyroid. Some studies have shown that higher levels of exposure were associated with lower IQ or adhd. Other studies show that it could be harmful to a baby's neurological development. And then last year, a big report looking into fluoride was published by the National Toxicology Program.

[Chris Maher]

The National Toxicology Program is part of the Department of Health and Human Services. It's a group of federal scientists who look at, you know, whether substances are, or chemicals are toxic. So they, they investigate chemicals for the federal government.

[Ryan Knudsen]

The report, which came out in August, validated some of those concerns about fluoride. It found that at high levels, levels double what is allowed in US Drinking water, fluoride could negatively impact kids.

[Dr. Joseph Latapo]

A US Government report from the National Toxicology Program concluding that fluoride at 1.5 milligrams per liter, twice the recommended amount in drinking water, is linked to lower IQ levels in children.

[Chris Maher]

So children that had been exposed to fluoride at higher levels had IQ deficits. So fairly earth shattering for this conclusion to come out.

[Ryan Knudsen]

The report found with moderate confidence that elevated levels of fluoride could be associated with a decrease in iq. One month after the report came out, a judge issued a major ruling against fluoride. This came after a group of parents had petitioned the Environmental Protection Agency about fluoride.

[Chris Maher]

The EPA does not mandate fluoride in water, but what it does do is set the optimal level. So the judge said that the EPA had to take some kind of regulatory action. You know, he didn't say specifically what the EPA had to do, but he was saying that this is an unreasonable risk. You've got to take some sort of action. I mean, the action could be warning people that there's a risk. It could be lowering the recommended level. So this was a pretty groundbreaking ruling. It caught a lot of people's attention.

[Ryan Knudsen]

There's one more thing that's helped bring the fluoride debate into the mainstream. The rise of Robert F. Kennedy, Jr.

[Dr. Johnny Johnson]

I think fluoride is a poison, and.

[Ryan Knudsen]

It causes severe IQ loss. And last week, just before President Trump nominated him to run the Department of Health and Human Services, RFK made a big promise about fluoride back in November.

[Chris Maher]

He tweeted that the Trump administration would advise all public water systems to get fluoride out of the water. So on day one, you know, Trump was going to get fluoride out of the water.

[Ryan Knudsen]

That hasn't happened yet, but it could be getting closer. That's after the break.

[Christopher Mims]

I'm Christopher Mims of the Wall Street Journal. Every day we talk to the leaders behind Bold name companies, and you can hear from them in bold names from the Wall Street Journal wherever you get your podcasts.

[Ryan Knudsen]

The decision about whether or not to put fluoride in the water is generally up to local cities and towns. And now, with everything that's happened, the fluoride debate is catching fire.

[Chris Maher]

There's hundreds of places that have meetings scheduled that are planning to take a look at this issue. So hundreds around the country, probably in, I would guess, nearly every state or every state.

[Ryan Knudsen]

Chris attended one of those meetings in February in a town in Florida called Bartow.

[Chris Maher]

It's a city of 21,000 people. It's about an hour east of Tampa. They had been wrestling with the question of whether to keep Florida in their water.

[Ryan Knudsen]

Bartow held their fluoride town hall in the city's civic center. They had 50 chairs set out for residents, all filled with more people standing in the back.

[Chris Maher]

The two sides of the building were all glass, so one side looked out onto some little league fields that were pretty new. Lights were just coming on as the meeting was starting.

[Dr. Joseph Latapo]

And there's a podium right over there.

[Ryan Knudsen]

And Bartow's mayor was running the meeting.

[Dr. Joseph Latapo]

Dr. Johnny, are you ready?

[Ryan Knudsen]

The first person to speak was a pro fluoride lobbyist named Dr. Johnny Johnson. He travels around the country attending debates like this one.

[Chris Maher]

He is a retired dentist in his 60s. He's also the president of the American Fluoridation Society. So he's one of the most outspoken proponents of fluoride in the. In the country. He often wears a T shirt that says fluoridation question mark F. Yeah, so that's kind Of a. It's kind of an expression of his passion for this subject.

[Ryan Knudsen]

He must have been excited to be in Florida talking about fluoride. At the town hall in Florida, Johnson ditched the fluoride T shirt in favor of a button down. And he was serious about his support for fluoride.

[Chris Maher]

People die of dental infections that get into their bloodstream septice. He showed some slides that showed some, some mouths that had been really horribly decayed. And I think those were striking for people to see. That's horrible.

[Dr. Johnny Johnson]

We don't like to see that at all.

[Chris Maher]

He and other dentists argue that especially low income people may really be the ones who will lose out from fluoride being taken out of water because they don't have the best access to dental care necessarily. Maybe not even to fluoride toothpaste. From that perspective, this is potentially, you know, very risky for a large segment of the population.

[Ryan Knudsen]

Does Johnson or the rest of the dental industry have any financial incentives here? I mean, like, is there sort of like big fluoride that's trying to protect their business in some way?

[Chris Maher]

Really what they're saying is that, you know, it's not, it's not a financial issue. It's the patients that they treat, it's the suffering that they see. They don't want people to get cavities.

[Ryan Knudsen]

But is anybody making money off the fact that there's fluoride in the water and is that influencing this debate in any way?

[Chris Maher]

No. I mean, you take a town like Bartow or some of these other small communities, they're not spending a ton of money on fluoride or this chemical that creates the fluoride. They're spending maybe $20,000 a year. So it's not a tremendous amount of money.

[Ryan Knudsen]

At the town hall after Johnson finished speaking, the anti fluoride camp took the mic. One person there to represent it was Florida's Surgeon General, Dr. Joseph Latapo.

[Unknown]

Dental health, very important. Fortunately, there are alternatives, right? There's toothpaste, there's mouthwash. This isn't expensive stuff. I mean, this is stuff that people of all income levels can afford, Right?

[Ryan Knudsen]

Latapo said the benefits of fluoride were outweighed by the risks.

[Unknown]

This is a very simple issue. The cost in terms of human health is far too high to be fooling around with this. I mean, it actually is reckless for anyone who's knowledgeable to have the information and to continue doing it.

[Chris Maher]

It's very simple.

[Ryan Knudsen]

For now, localities are largely being left to make sense of the research themselves. Something Bartow's mayor said she felt like they shouldn't have to do.

[Dr. Joseph Latapo]

This is not our lane. We should be looking at, you know, planned developments and traffic and budget, health and treating the people of our city should not be our lane. But we're forced into it because this happened way back when and became the norm.

[Ryan Knudsen]

In March, the Bartow City Council came to a decision.

[Dr. Joseph Latapo]

Bartow city leaders have decided to continue adding fluoride to the city's water supply.

[Chris Maher]

Yeah.

[Ryan Knudsen]

The vote was signed, split during an emotionally charged meeting last night's bathroom. While Bartow decided to keep fluoride, other places are coming to different conclusions. Like in Utah last week where the governor signed a bill banning the addition of fluoride in drinking water. One thing Chris says he's watching for now is what RFK Jr does.

[Chris Maher]

The thing I'm looking for is definitely to see if there's going to be some federal guidance from EPA or from RFK Jr. Himself or the Department of Health and Human Services telling public water systems to either take fluoride out just as an advisory. I think that would have a really significant effect.

[Ryan Knudsen]

With these fights happening all across the country, is there a sense right now that fluoride is generally winning or losing?

[Chris Maher]

I think right now the anti fluoride movement has the upper hand. There seem to be more places, you know, first of all, more places are putting it to a vote and then when they do, they're voting the fluoride out. Even Johnny Johnson will say, I'm, he's scrambling. He's working constantly to try to address these, put out these fires around the country and to try to fight this fight. And, you know, I think he's, he's losing more of these battles than he, than he ever did.

[Ryan Knudsen]

That's all for today. Friday, April 4th. The Journal is a co production of Spotify and the Wall Street Journal. The show's made by Kathryn Brewer, Pia Gadkari, Rachel Humphries, Sophie Kodner, Matt Kwong, Kate Limebaugh, Jessica Mendoza, Colin McNulty, Annie Minoff, Laura Morris, Enrique Perez de la Rosa, Sarah Platt, Alessandra Rizzo, Alan Rodriguez Espinosa, Heather Rogers, Pierce Singhe, Jeevika Verma, Lisa Wang, Catherine Whalen, Tatiana Zamis and me, Ryan Knudsen with help from Trina Menino. Our engineers are Griffin Tanner, Nathan Singapak and Peter Leonard. Our theme music is by so Wiley. Additional music this week by Peter Leonard, Bobby Lord, Emma Munger, Nathan Singapak, so Wiley Epidemic Sound and Blue Dot sessions. Fact checking this week by Mary Mathis, Kate Gallagher, and Najwa Jamal. Thanks for listening. See you Monday.

[Tim Higgins]

Every day, Wall Street Journal reporters talk with the most powerful, influential, and interesting people. And now we're bringing some of those conversations directly to you. I'm Tim Higgins.

[Christopher Mims]

And I'm Christopher Mims. We're teaming up to ask tough questions of the leaders behind the bold name companies found in the pages of the Journal Every day. Are you going to build that $20,000 vehicle?

[Ryan Knudsen]

No, because that market sucks.

[Tim Higgins]

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