James Flanagin, the one dentist in Leslie, Ark., treats David Potts. About 25 million Individuals reside in dentist scarcity areas, based on new analysis from Harvard College.
Katie Adkins/KFF Well being Information
conceal caption
toggle caption
Katie Adkins/KFF Well being Information
Within the wooded highlands of northern Arkansas, the place small cities have few dentists, water officers who serve greater than 20,000 folks have for greater than a decade brazenly defied state legislation by refusing so as to add fluoride to the ingesting water.
For its refusal, the Ozark Mountain Regional Public Water Authority has obtained a whole bunch of state fines amounting to about $130,000, that are stuffed in a cardboard field and left unpaid, stated Andy Anderson, who’s against fluoridation and has led the water system for practically 20 years.
This Ozark area is amongst a whole bunch of rural American communities that face a one-two punch to oral well being: a dire scarcity of dentists and a scarcity of fluoridated ingesting water, which is extensively considered amongst dentists as one of the vital efficient instruments to stop tooth decay.
However because the anti-fluoride motion builds unprecedented momentum, it could end up that the Ozarks weren’t behind the occasions in any case.
“We are going to finally win,” Anderson stated. “We might be vindicated.”
Fluoride, a naturally occurring mineral, retains enamel sturdy when added to ingesting water, based on the Facilities for Illness Management and Prevention and the American Dental Affiliation. However the anti-fluoride motion has been energized since authorities scientists printed a report final summer time discovering a potential hyperlink between decrease IQ in kids and consuming quantities of fluoride which might be larger than what’s really helpful in American ingesting water.
Dozens of communities have determined to cease fluoridating in current months, and state officers in Florida and Texas have urged their water techniques to do the identical. Utah is poised to turn out to be the primary state to ban it in faucet water.
Division of Well being and Human Providers Secretary Robert F. Kennedy Jr., who has lengthy espoused fringe well being theories, has known as fluoride an “industrial waste” and “harmful neurotoxin” and stated the Trump administration will advocate it’s faraway from all public ingesting water.
A storage tank in northern Arkansas holds water from the Ozark Mountain Regional Public Water Authority, which has defied a state legislation requiring fluoride to be added to ingesting water for greater than a decade.
Katie Adkins/KFF Well being Information
conceal caption
toggle caption
Katie Adkins/KFF Well being Information
Individually, Republican efforts to increase tax cuts and shrink federal spending could squeeze Medicaid, which may deepen shortages of dentists in rural areas the place many residents depend upon the federal insurance coverage program for no matter dental care they will discover.
Dental specialists warn that the simultaneous erosion of Medicaid and fluoridation may exacerbate a disaster of rural oral well being and reverse a long time of progress towards tooth decay, significantly for kids and people who not often see a dentist.
“In case you have people with little entry to skilled care and no entry to water fluoridation,” stated Steven Levy, a dentist and main fluoride researcher on the College of Iowa, “then they’re lacking two of the massive pillars of the way to maintain wholesome for a lifetime.”
Many already are.
Overlapping ‘dental deserts’ and fluoride-free zones
Almost 25 million Individuals reside in areas with out sufficient dentists — greater than twice as many as prior estimates by the federal authorities — based on a current research from Harvard College that measured U.S. “dental deserts” with extra depth and precision than earlier than.
Hawazin Elani, a Harvard dentist and epidemiologist who co-authored the research, discovered that many scarcity areas are rural and poor, and rely closely on Medicaid. However many dentists don’t settle for Medicaid as a result of funds could be low, Elani stated.
The ADA has estimated that solely a 3rd of dentists deal with sufferers on Medicaid.
“I believe this example is far worse for Medicaid beneficiaries,” Elani stated. “In case you have Medicaid and your nearest dentists don’t settle for it, then you’ll seemingly should go to the third, or fourth, or the fifth.”
The Harvard research recognized over 780 counties the place greater than half of the residents reside in a scarcity space. Of these counties, no less than 230 even have largely or utterly unfluoridated public ingesting water, based on a KFF Well being Information evaluation of fluoride information printed by the CDC. Which means folks in these areas who cannot discover a dentist additionally don’t get safety for his or her enamel from their faucet water.
The KFF evaluation doesn’t cowl all the nation as a result of it doesn’t embody personal wells and 13 states don’t submit fluoride information to the CDC. However amongst those who do, most counties with a scarcity of dentists and unfluoridated water are within the south-central U.S., in a cluster that stretches from Texas to the Florida Panhandle and up into Kansas, Missouri, and Oklahoma.
Within the middle of that cluster is the Ozark Mountain Regional Public Water Authority, which serves the Arkansas counties of Boone, Marion, Newton, and Searcy. It has refused so as to add fluoride ever since Arkansas enacted a statewide mandate in 2011. After weekly fines started in 2016, the water system unsuccessfully challenged the fluoride mandate in state court docket, then misplaced once more on attraction.
Anderson, who has chaired the water system’s board since 2007, stated he want to problem the fluoride mandate in court docket once more and would argue the case himself if mandatory. In a cellphone interview, Anderson stated he believes that fluoride can hamper the mind and physique to the purpose of constructing folks “get fats and lazy.”
Close by within the tiny, no-stoplight neighborhood of Leslie, Ark., which will get water from the Ozark system, the one dentist on the town operates out of a one-man clinic tucked behind an vintage retailer. Hand-painted lettering on the shop window advertises a “fairly good dentist.”
James Flanagin, a third-generation dentist who opened this clinic three years in the past, stated he was drawn to Leslie by the quaint charms and pleasant smiles of small-town life. However those self same smiles additionally reveal the unmistakable penalties of refusing to fluoridate, he stated.
“There is no such thing as a doubt that there’s extra dental decay right here than there would in any other case be,” he stated. “You’re going to have extra decay in case your water just isn’t fluoridated. That is only a truth.”
James Flanagin, the one dentist within the tiny Arkansas city of Leslie, which additionally has unfluoridated ingesting water, treats sufferers behind an vintage retailer on Principal Road.
Katie Adkins/KFF Well being Information
conceal caption
toggle caption
Katie Adkins/KFF Well being Information
Fluoride’s public well being impacts
Fluoride was first added to public water in an American metropolis in 1945 and unfold to half of the U.S. inhabitants by 1980, based on the CDC. Due to “the dramatic decline” in cavities that adopted, in 1999 the CDC dubbed fluoridation as one among 10 nice public well being achievements of the twentieth century.
At present greater than 70% of the U.S. inhabitants on public water techniques get fluoridated water, with a really helpful focus of 0.7 milligrams per liter, or about three drops in a 55-gallon barrel, based on the CDC.
Fluoride can also be current in trendy toothpaste, mouthwash, dental varnish, and some meals and drinks — like raisins, potatoes, oatmeal, espresso, and black tea. However a number of dental specialists stated these merchandise don’t reliably attain as many low-income households as ingesting water, which has a further profit over toothpaste of strengthening kids’s enamel from inside as they develop.
Two current polls have discovered that the most important share of Individuals help fluoridation, however a large minority doesn’t. Polls from Axios/Ipsos and AP-NORC discovered that 48% and 40% of respondents wished to maintain fluoride in public water provides, whereas 29% and 26% supported its elimination.
Chelsea Fosse, an skilled on oral well being coverage on the American Academy of Pediatric Dentistry, stated she apprehensive that misguided fears of fluoride would trigger many individuals to cease utilizing fluoridated toothpaste and polish simply as Medicaid cuts made it more durable to see a dentist.
The mixture, she stated, may very well be “devastating.”
“Will probably be visibly obvious what this does to the prevalence of tooth decay,” Fosse stated. “If we eliminate water fluoridation, if we make Medicaid cuts, and if we do not help suppliers in finding and serving the highest-need populations, I actually do not know what we are going to do.”
A number of peer-reviewed research have proven what ending water fluoridation may seem like. Up to now few years, research of cities in Alaska and Canada have proven that communities that stopped fluoridation noticed vital will increase in kids’s cavities compared with comparable cities that didn’t. A 2024 research from Israel reported a “two-fold improve” in dental therapies for teenagers inside 5 years after the nation stopped fluoridating in 2014.
Regardless of the advantages of fluoridation, it has been fiercely opposed by some since its inception, stated Catherine Hayes, a Harvard dental skilled who advises the American Dental Affiliation on fluoride and has studied its use for 3 a long time.
Fluoridation was initially smeared as a communist plot towards America, Hayes stated, after which later fears arose of potential hyperlinks to most cancers, which had been refuted by means of intensive scientific analysis. Within the ’80s, hysteria fueled fears of fluoride inflicting AIDS, which was “ludicrous,” Hayes stated.
Extra not too long ago, the anti-fluoride motion seized on worldwide analysis that means excessive ranges of fluoride can hinder kids’s mind improvement and has been boosted by high-profile authorized and political victories.
Final August, a hotly debated report from the Nationwide Institutes of Well being’s Nationwide Toxicology Program discovered “with reasonable confidence” that publicity to ranges of fluoride which might be larger than what’s current in American ingesting water is related to decrease IQ in kids. The report was based mostly on an evaluation of 74 research carried out in different international locations, most of which had been thought of “low high quality” and concerned publicity of no less than 1.5 milligrams of fluoride per liter of water — or greater than twice the U.S. advice — based on this system.
Dentist James Flanagin operates out of a small clinic behind an vintage retailer in Leslie, Ark. Leslie is one among a whole bunch of American communities, largely rural, which have each a scarcity of dentists and unfluoridated ingesting water.
Katie Adkins/KFF Well being Information
conceal caption
toggle caption
Katie Adkins/KFF Well being Information
The next month, in a long-simmering lawsuit filed by fluoride opponents, a federal choose in California stated the potential hyperlink between fluoride and lowered IQ was too dangerous to disregard, then ordered the federal Environmental Safety Company to take nonspecified steps to decrease that danger. The EPA began to attraction this ruling within the closing days of the Biden administration, however the Trump administration may reverse course.
The EPA and Division of Justice declined to remark. The White Home and Division of Well being and Human Providers didn’t reply to questions on fluoride.
Regardless of the Nationwide Toxicology Program’s report, Hayes stated, no affiliation has been proven so far between lowered IQ and the quantity of fluoride really current in most Individuals’ water. The court docket ruling could immediate further analysis carried out within the U.S., Hayes stated, which she hoped would lastly put the marketing campaign towards fluoride to relaxation.
“It is one of many nice mysteries of my profession, what sustains it,” Hayes stated. “What considerations me is that there is some perception amongst some members of the general public — and a few of our policymakers — that there’s some fact to this.”
Not all specialists had been so dismissive of the toxicology program’s report. Dr. Bruce Lanphear, a kids’s well being researcher at Simon Fraser College in Canada, printed an editorial in January that stated the findings ought to immediate well being organizations to “reassess the dangers and advantages of fluoride, significantly for pregnant girls and infants.”
“The people who find themselves proposing fluoridation have to now show it is protected,” Lanphear advised NPR in January. “What the research does, or ought to do, is shift the burden of proof.”
Cities and states rethink fluoride
Not less than 14 states up to now this 12 months have thought of or are contemplating payments that may carry fluoride mandates or prohibit fluoride in ingesting water altogether. In February, Utah lawmakers handed the nation’s first ban, which Republican Gov. Spencer Cox advised ABC4 Utah he intends to signal. And each Florida Surgeon Basic Joseph Ladapo and Texas Agriculture Commissioner Sid Miller have known as for his or her respective states to finish fluoridation.
“I do not need Huge Brother telling me what to do,” Miller advised The Dallas Morning Information in February. “Authorities has compelled this on us for too lengthy.”
Moreover, dozens of cities and counties have determined to cease fluoridation previously six months — together with no less than 16 communities in Florida with a mixed inhabitants of greater than 1.6 million — based on information stories and the Fluoride Motion Community, an anti-fluoride group.
Stuart Cooper, govt director of that group, stated the motion’s unprecedented momentum could be additional supercharged if Kennedy and the Trump administration comply with by means of on a advice towards fluoride.
“I feel what you’re seeing in Florida, the place each neighborhood is falling like dominoes, goes to now occur in the US,” he stated. “I feel we’re seeing absolutely the finish of it.”
If Cooper’s prediction is true, Hayes stated, widespread decay could be seen inside years. Youngsters’ enamel will rot of their mouths, she stated, though “we all know the way to utterly stop it.”
“It is pointless ache and struggling,” Hayes stated. “When you go into any kids’s hospital throughout this nation, you will see a ready checklist of youngsters to get into the working room to get their enamel fastened as a result of they’ve extreme decay as a result of they have not had entry to both fluoridated water or different sorts of fluoride. Sadly, that is simply going to worsen.”
Dentist shortages and unfluoridated Water: Methodology
This KFF Well being Information article identifies communities with an elevated danger of tooth decay by combining information on areas with dentist shortages and unfluoridated ingesting water. The evaluation merged Harvard College analysis on dentist-shortage areas with giant datasets on public water techniques printed by the U.S. Facilities for Illness Management and Prevention.
The Harvard analysis decided that just about 25 million Individuals reside in dentist-shortage areas that span a lot of rural America. The CDC information particulars the populations served and fluoridation standing of greater than 38,000 public water techniques in 37 states. KFF Well being Information labeled counties as having elevated danger of tooth decay in the event that they met three standards:
- Greater than half of the residents reside in a dentist-shortage space recognized by Harvard.
- The variety of folks receiving unfluoridated water from water techniques based mostly in that county quantities to greater than half of the county’s inhabitants.
- The variety of folks receiving unfluoridated water from water techniques based mostly in that county quantities to no less than half of the full inhabitants of all water techniques based mostly in that county, even when these techniques reached past the county borders, which many do.
The evaluation recognized roughly 230 counties that meet these standards, which means they’ve each a dire scarcity of dentists and largely unfluoridated ingesting water.
However this complete is actually an undercount. 13 states don’t report water system information to the CDC, and the company information doesn’t embody personal wells, most of that are unfluoridated.
KFF Well being Information is a nationwide newsroom that produces in-depth journalism about well being points and is likely one of the core working packages at KFF.
