Last year, when Utah lawmakers passed the nation’s first statewide ban on community water fluoridation, they included a provision making it easier for people to get fluoride supplements without having to visit a dental provider.
This would make fluoride available through individual choice, rather than “mass public dosing,” as a Utah House of Representatives webpage put it — part of the rising rhetoric of skepticism that’s led to rollbacks of water fluoridation, a proven method to reduce tooth decay.
“It’s what I like to refer to as the win-win, right?” Speaker Mike Schultz said on a June episode of the “House Rules” podcast from the Utah House. “Those that want fluoride can now get fluoride easier, and those that don’t want fluoride in their drinking water don’t have to have that.”
But even as critics point to fluoride supplements as an alternative — along with fluoride toothpaste, rinses and varnishes — many are creating barriers to these same products.
Under U.S. Health and Human Services Secretary Robert F. Kennedy Jr.’s oversight, the Food and Drug Administration said it issued notices to four businesses about their ingestible fluoride supplements for children and also put out new guidance for health professionals.
In Texas, Attorney General Ken Paxton launched investigations into two large companies over their marketing of fluoride toothpaste to parents and children.
And changes to Medicaid in President Donald Trump’s so-called One Big Beautiful Bill Act threaten to make it harder than it already is for the most vulnerable people to access any oral health care at all, let alone fluoride treatments at a dentist’s office.
More than anything, experts say, alarmist language from high-profile officials is trickling down to the public, leading more people to question whether any form of fluoride — in drinking water or in other treatments — is a good idea.
Scott Tomar, a professor and associate dean at the University of Illinois Chicago College of Dentistry, is among those who have watched with dismay as the conversation about fluoride has been affected by arguments likely to scare people.
“I’m certain that the net result of all of this is going to be a greater reluctance on the part of parents and providers to prescribe fluoride supplements,” Tomar said.
Low, consistent exposure to fluoride is widely credited for dramatic declines in decaying teeth. But long-simmering skepticism about its use gained more influence in recent years, especially with Kennedy’s credibility and influence as the nation’s chief health officer.
“The evidence against fluoride is overwhelming,” he said as he stood alongside Utah lawmakers at a press conference in Salt Lake City last April.
Even though the science to support his conclusions is limited, he claimed that fluoride “causes IQ loss, profound IQ loss,” and he linked water fluoridation to ADHD, hypothyroidism, osteoarthritis, and kidney and liver issues.
Lee Zeldin, who leads the Environmental Protection Agency, spoke at the Utah event, too, crediting Kennedy for helping to spur the agency’s review of its standard for fluoride in drinking water. An EPA spokesperson, in a statement to ProPublica, said that the agency’s “next analysis of new scientific information on potential health risks of fluoride in drinking water was not due until 2030, but this agency is moving at Trump Speed.”
Meanwhile, the FDA is partnering with other federal agencies to develop what it called “a fluoride research agenda.” And, as part of a series of drastic cutbacks last spring, the Division of Oral Health at the Centers for Disease Control and Prevention was eliminated.
In a statement emailed to ProPublica, an HHS spokesperson argued that fluoride’s “predominant benefit to teeth comes from topical contact with the outside of the teeth, not from ingestion. There is no need, therefore, to ingest fluoride.”
Fluoride’s opponents cite a hotly debated “state of the science” report from the National Toxicology Program in 2024, saying that it shows an association between fluoride exposure and a lowered IQ in children.
But those findings are not widely embraced because of the review’s limitations. It analyzed studies conducted outside the U.S., with different water conditions, and involving fluoride levels at more than twice the standard for drinking water here. The report itself states, in bold type, that it does not address “whether the sole exposure to fluoride added to drinking water” at the recommended level in the United States and Canada “is associated with a measurable effect on IQ.”
In this atmosphere, as ProPublica has reported, there’s been widespread wavering on water fluoridation, even in Michigan, where the treatment debuted more than 80 years ago.
Florida joined Utah in banning fluoridation statewide. Bills to do the same were introduced in at least 19 other states last year, and that momentum is carrying forward, with statewide bans recently proposed in Arizona and South Carolina. Meanwhile, local debates over fluoridation are turning raucous.
Utah’s dental professionals are concerned about how to stave off an expected hit to oral health, as other communities experienced when they cut off fluoridation.
“We get heartburn over the situation,” said James Bekker, a pediatric dentist and past president of the Utah Dental Association.
Bekker and others are piecing together ways to provide other forms of fluoride treatment to Utahns. But he’s worried, he said, about “all these susceptible, vulnerable children in underserved populations that don’t have a choice and don’t have a voice, but they are going to suffer.”
Shortly after Utah banned fluoridation, the FDA took aim at the kind of supplements that lawmakers had presented as a key alternative. The agency announced that it was working to remove certain ingestible fluoride products for children from the market. Its press release described associations with changes to the gut microbiome, thyroid disorders, weight gain “and possibly decreased IQ.”
More than 4,600 public comments poured into the FDA, including many from people worried about losing access to supplements while simultaneously losing water fluoridation.
“Now that fluoride has been removed from much of Utah’s water, it is imperative to provide supplementation through other means,” one orthodontist wrote. A dentist in South Florida criticized the scare tactics and bad science leading states like hers to ban fluoridation and said that prescribing fluoride drops and lozenges is one of the few alternatives for pediatric patients.
On Oct. 31, the FDA announced efforts to “restrict the sale of unapproved ingestible fluoride prescription drug products for children.” The agency said it sent notices to four companies about marketing the supplements for children under 3 and older children with moderate or low risk for tooth decay. It also said it issued letters to health care professionals “warning about the risks associated with these products.”
Even though the FDA landed short of a ban, Stuart Cooper, executive director of the Fluoride Action Network, called the agency’s shift a “major victory.” He said he believes it’s just the start of federal action to limit the use of fluoride products that FAN has long campaigned against.
Fluoride supplements, which emerged in the 1940s alongside water fluoridation, never went through an FDA review. A decade ago, Cooper said, FAN submitted a citizens petition that called for the agency to pull ingestible fluoride supplements from the market. “What we’re seeing is that come to fruition,” he said, “because we finally have FDA employees who were willing to look at the issue.”
The FDA’s stance on supplements is now at odds with several health organizations, including the American Dental Association, the American Academy of Pediatric Dentistry and the American Academy of Pediatrics. Several of them jointly support a graduated fluoride supplementation schedule that starts at six months for high-risk children.
Johnny Johnson, a retired pediatric dentist in Florida, questions the FDA’s risk parameters. “If you don’t have fluoride at appropriate levels in your water, by definition, you are at high risk” of tooth decay, said Johnson, who heads the nonprofit American Fluoridation Society.
The FDA’s letter to health professionals recommends topical fluoride as an alternative, such as toothpaste. But even that method faces scrutiny. The Texas attorney general’s office launched investigations into Colgate-Palmolive and Procter & Gamble, which sell Colgate and Crest fluoride toothpastes.
Their marketing to parents and children is “misleading, deceptive and dangerous,” Paxton’s office said in a press release. Referencing the NTP report on fluoridation, the release said the investigation came “amid a growing body of scientific evidence demonstrating that excessive fluoride exposure is not safe for children.”
In September, Paxton’s office announced a “historic agreement” with Colgate-Palmolive. When its packaging and promotional material for children’s fluoride toothpaste shows the paste on a brush, the company will display a pea-sized amount, rather than the traditional swirl. This month, Paxton’s office reported a similar settlement with Procter & Gamble.
A representative from Colgate-Palmolive said in a statement to ProPubica that Paxton’s press release acknowledged that “we already provide directions on our packaging that complies with U.S. FDA requirements for how our children’s fluoride toothpastes should be used.” Procter & Gamble said in a statement that “the Texas Attorney General acknowledged in the settlement that our products comply with all laws and regulations regarding directions for use.”
Another tool for fluoride treatment is varnish applied during a dental checkup, which may be provided at free or reduced cost through insurance programs. But even with health coverage, there are barriers that often make it difficult to see the dentists and pediatricians providing such treatment. Recent research found that insurance denials for fluoride varnish applications can add another layer of complication for patients and providers.
Supplemental fluoride treatments are limited, compared with the effectiveness, reach and cost of fluoride in drinking water, said Johnson, the retired pediatric dentist, but “it is the only option that we have in Florida and in Utah.”
“Nothing replaces fluoridated water,” he added. “Nothing comes close.”