Fluoridation Debate Turns Raucous in a Michigan Community — ProPublica

On the far east side of Michigan, the future of fluoride in drinking water — long an ordinary practice for preventing tooth decay — has suddenly provoked passionate debate.

Public meetings in St. Clair County, about an hour northeast of Detroit, have filled with people weighing in. One man waved his Fixodent denture cream before the county commissioners, suggesting that his own experience showed what would happen if local communities stopped treatment.

“I am an unfluoridated child,” he declared, “with a set of uppers and lowers.”

Another man, speaking to the county’s Advisory Board of Health, said that personal responsibility should be factored into the conversation. “I think there are some 3 Musketeer bars, Snicker bars that should be accounted for. Some Coca-Colas.”

And a young man used his time in the public comments to address not just fluoridation, but the county medical director who’s trying to get rid of it. He accused him of grandstanding to land a job with Robert F. Kennedy Jr., the U.S. health and human services secretary, by making moves that “lowered the quality of life for underserved people.”

The raucous arguments were spurred by a three-page memo sent in June to the Advisory Health Board by Dr. Remington Nevin, the medical director of St. Clair County’s Health Department. It urges the department to take steps to “prohibit the addition of fluoride” to public water systems because, he wrote in bold print, the additive is “a plausible developmental neurotoxicant” — a claim that runs counter to the assessment of many leading experts and health agencies, which have long celebrated fluoridation as a public health triumph.

Nevin recommended fluoride restrictions that would apply to any system located in the county and serving county residents. Potentially, that could include the Great Lakes Water Authority, which provides water to nearly 40% of the state’s population.

Drinking water fluoridation, which was pioneered in Michigan in 1945, led to a massive drop in tooth decay. Even with the rise of fluoride in toothpaste and other products, it’s credited with a 25% decrease in cavities. But skeptics increasingly hold sway in government, as ProPublica recently reported. Those opponents include Kennedy, the nation’s top health official, who has called fluoride “industrial waste.”

Now the Centers for Disease Control and Prevention and the Environmental Protection Agency are reviewing their approaches to fluoride in drinking water, and Utah and Florida became the first states to ban fluoridation.

Local communities, though, are on the front lines of the fluoride wars in most states, typically deciding whether or not to continue fluoridating their drinking water by council vote or community referendum. The public conversation in St. Clair County offers a vivid example of how contentious the issue can become. Advocates from well beyond its borders are getting involved, saying that what happens in the county has implications for the entire state.

Home to about 160,000 residents at the base of Michigan’s Thumb, St. Clair County shares a watery border with Canada. Some 67% of its voters chose President Donald Trump in the 2024 election. (Kennedy got under 1% of the vote.) About 110,000 residents receive fluoridated drinking water, according to the state’s environmental agency, while an additional 6,510 are served by water supplies with naturally occurring fluoride.

In his memo this summer, Nevin, who is a physician epidemiologist, cited a state-of-the-science report from the National Toxicology Program last year that described an association between higher levels of fluoride exposure and lower IQs in children. (The NTP is an interagency program within the Department of Health and Human Services that’s focused on toxicology research.)

Nevin also referenced a court decision in a case filed against the EPA by groups opposed to fluoridation, where a district judge relied, in part, on the NTP report in ruling that fluoride presented an “unreasonable risk.” Even as it appeals the decision, the EPA said its review of new science on fluoride in drinking water “is being done in coordination with Secretary Kennedy and HHS.”

The NTP report, though, is contested and based on limited studies involving fluoride levels that are more than twice the amount recommended by the federal government. Its own abstract says there isn’t enough information to link lower fluoride exposure with children’s IQ.

Nevin’s memo said that the EPA may take months or years to act on fluoride, but that didn’t mean local officials had to wait. “Across the Michigan Thumb, several townships have expressed a desire for similar measures,” he wrote, “and within St. Clair County, I have received a number of resident concerns related to this issue.” He recommended new regulations that would prohibit the addition of “any form of fluoride” to public water systems in the county that serve residents.

In Michigan, each community decides for itself if it will maintain fluoride in its drinking water system. But in an email to ProPublica, Nevin laid out a process where the St. Clair County Board of Commissioners could approve regulations that, in the name of public health, restrict the ability of suppliers to use the additive — in effect, enacting sweeping change throughout the region.

“Just as items manufactured in California are often subject to more stringent California environmental and health regulations, even if the majority are sold outside the state; so too could drinking water produced in St. Clair County be subject to more stringent county regulations, even if the majority is exported to other counties,” he wrote.

Whether or not this applies to any future fluoride regulations depends on the language that is adopted and approved, he added.

The state Department of Health and Human Services says it knows of no local health departments that have attempted such restrictions. In response to ProPublica’s queries, the Great Lakes Water Authority shared a May statement about fluoride, which says that the agency is required by its owner, the city of Detroit, to fluoridate its water supply. The current dosage is well below the maximum established by the Safe Drinking Water Act and the EPA, the statement said, and is in line with the recommended target for oral health benefits.

The water authority, which serves southeast Michigan, didn’t address the St. Clair County proposal. And it’s unclear whether the push for broad county regulations will gain traction.

As medical director, Nevin has an influential voice with county officials and shares guidance with Liz King, the county’s health officer-director. King, however, expressed reservations about Nevin’s proposal at a July meeting of the Advisory Health Board, according to the minutes.

In a statement to ProPublica, King said: “I do not support county-wide mandates to remove fluoride or actions that override the authority of local jurisdictions, unless there is an emergent or urgent public health need.”

Nevin was new to Michigan when he joined the Health Department in his part-time position about two years ago. He soon established that he would be an active force. He describes it in an email to ProPublica as “counter-activism,” adding: “I am largely working to counter the radical agendas of many past and current state public health officials.”

At the January meeting of the Advisory Health Board, Nevin provided members with a 2022 book by Kennedy — “A Letter to Liberals: Censorship and COVID: An Attack on Science and American Ideals” — that’s critical of the Democratic Party and government restrictions enacted during the COVID-19 pandemic. (To the notion that he wants to work for Kennedy, Nevin told ProPublica that it’s “baseless conjecture” and that he’s happy in St. Clair County.)

Less than a year into his tenure as HHS secretary, Kennedy’s approach was challenged by six former surgeons general who served under both Republicans and Democrats. In a recent op-ed, they said that Kennedy is “endangering the health of the nation.” His agency criticized their track records in office when contacted by ProPublica about the op-ed, saying they failed to improve public health.

Nevin has moved to make vaccine exemptions easier to get, saying in an April memo that it would “improve the public’s trust in public health.” Those efforts helped earn him a tribute signed by 10 Republican state legislators, which also highlights his fluoride recommendations. Nevin also successfully pushed for the department to wind down services at school health clinics, arguing, in part, that providing direct primary care isn’t a core function of public health.

Supporters point to his training in the military and at Johns Hopkins University. In addition to a medical degree, his CV lists a master’s degree and doctorate in public health. On his website, Nevin also highlights his ability to serve as an expert witness and consultant in legal cases that involve adverse effects from certain antimalarial drugs.

Nevin told ProPublica that past experience taught him that it can take years for neurotoxic effects of certain substances to be recognized. “I have every confidence that, in due course, fluoride will also be looked upon as a neurotoxicant that has no place being ingested,” he wrote in an email.

He added that the response he’s received to his proposal from the community “has been overwhelmingly positive.”

But there’s been strong pushback. Dr. Randa Jundi-Samman, a recently retired dentist in St. Clair County, was one of the health professionals speaking in support of fluoridation at public meetings. She told ProPublica that dropping fluoridation would be a serious hit to community health.

“You’d 100% get more decay, especially in children in low-income communities that don’t get the chance to go to the dentist every six months,” Jundi-Samman said. “We certainly will see that. We already see it in people who don’t have fluoride in their water.”

Dr. Mert Aksu, president of the Michigan Oral Health Coalition’s board and dean of the University of Detroit Mercy’s dental school, said he’s hustling up to the public meetings in St. Clair County because it’s the duty of professionals “to make sure that the decisions that are being made within our communities are being made based upon scientific merit.”

Speaking broadly about the influence now wielded by fluoride skeptics, Aksu said, “We have opened ourselves up to opportunities from misinformed people who want to use this issue for political purposes.”

At an August meeting of the county commissioners, Kimberly Raleigh, interim executive director of the Michigan Oral Health Coalition, read a letter in support of fluoridation that was signed by the University of Michigan School of Dentistry, the Michigan Dental Association, the Indiana Dental Association, the Pennsylvania Coalition for Oral Health and dozens of others.

Nevin said in an email that the dental community “must recognize that community water fluoridation can no longer be relied upon to mask the dental problems created by our neglect of poor dietary choices.”

He argues that he has science on his side. “Scientific merit favors a recommendation to prohibit fluoride,” he wrote to ProPublica. “I have every confidence this will become much clearer in the coming months, as further federal guidance is inevitably released.”

Nevin’s recommendation is before the Advisory Health Board, which also was provided a fact sheet on fluoridation from the Health Department, submitted with Nevin’s approval. If the board endorses his proposal, King may then decide whether to propose regulations, which the Board of Commissioners would then weigh, according to the Health Department. Nevin estimated that the process could take six to 12 months.

Fluoride was on the agenda for the Advisory Health Board’s September meeting, which ended early because the members failed to reach a quorum. Nevin told ProPublica that he expects it to be discussed at this week’s meeting, and that he will present additional information then.

Meanwhile, Nevin has already influenced one of the county’s townships, Kimball, which receives treated water from Port Huron, the seat of St. Clair County.

At an August meeting, where Nevin spoke to the Board of Trustees, Kimball Township unanimously passed a resolution calling for Port Huron to discontinue fluoridation and direct any funds saved to support access to topical dental fluoride treatments.

Port Huron’s city manager declined to comment for this story, saying the township has not presented the city with any resolution or request. Nevin said in an email to ProPublica that he is “attempting to address every municipality in the county” with similar testimony.

After voting on the measure, one Kimball trustee made a point to show support for Nevin, saying “we’re blessed to have him making decisions.”

Nevin, he said, has had to overcome resistance from staff “pushing hard to make his life rather uncomfortable.”

“They’re not used to leadership,” the trustee said. “They’re not used to boldness. They’re not used to maybe some male energy that’s necessary to get things done.”