Under a Trump presidency, fluoride will be eliminated from America’s public water supply, according to Robert F. Kennedy Jr.

The claim comes from a post on X, shared by Kennedy on Saturday, just days before the 2024 presidential election.

“On January 20, the Trump White House will recommend that all U.S. water systems remove fluoride from public water,” Kennedy wrote. “Fluoride is an industrial waste associated with arthritis, bone fractures, bone cancer, IQ loss, neurodevelopmental disorders, and thyroid disease. President @realDonaldTrump and First Lady @MELANIATRUMP want America healthy again.”

in a follow-up mailKennedy called fluoride a “dangerous neurotoxin.”

Water fluoridation, or adding fluoride to drinking water, has been a practice for decades in the United States, but Kennedy’s claims have raised questions about the safety of fluoride in drinking water and what would happen if it were removed from America’s water supply. USA. Here’s what you need to know.

Fluoride It is a natural mineral that can help prevent cavities and strengthen bones. Fluoride is often found in the water supply and in a variety of dental products, including toothpaste and mouthwashes, to prevent dental cavities.

Almost all water contains some natural fluoride, but usually not enough to maintain dental health, so local governments began adding fluoride to water systems in the 1940s. By 2020, more than 72% of the total US population, or about 290 million people, received fluoridated water through a community water system.

Water fluoridation is not required by law, and it is up to state and local governments to decide whether to add fluoride to their water supplies. The U.S. Department of Health and Human Services (HHS) set the optimal concentration of fluoride in drinking water at 0.7 milligrams of fluoride per liter of water. While water fluoridation typically involves the addition of fluoride, communities could remove it if the natural level is too high.

According to the Centers for Disease Control and Prevention (CDC), drinking fluoridated water reduces cavities by about 25% in children and adults, resulting in less mouth painfewer fillings or tooth extractions and fewer days missed from work and school. It’s worth noting that a Cochrane review published in October 2024 found that the benefit of community water fluoridation on cavities has declined since the 1970s, when fluoridated toothpaste became more available.

Experts say this is a complicated question: Research shows that the health risks associated with fluoride are based on the level of exposure.

“The science of fluoride is very interesting, because fluoride in small amounts is beneficial while in high doses it is toxic.” Athanasios Zavras, DDS, MS, DMScsaid Delta Dental of Massachusetts, professor of public health and community service at Tufts University School of Medicine and chair of the school’s Department of Public Health and Community Service. Health.

But for now, there are no confirmed health risks from fluoride at optimal levels. “There is no evidence to support claims that 0.7 mg/L fluoride leads to any of the conditions mentioned,” Zavras said.

That said, fluoride has been associated with some adverse health outcomes at higher levels, according to Ashley Malin, PhDassistant professor of epidemiology at the University of Florida College of Public Health and Health Professions.

Fluoride and neurodevelopment

Malin primarily studies the effect of fluoride on neurological development and there is some evidence that points to a link between the two.

In August, a report from the National Toxicology Program found that higher levels of fluoride exposure, such as drinking water with more than 1.5 mg of fluoride per liter (mg/L), is associated with lower IQ in children. children.

Most of the studies included in the report were conducted in countries outside the U.S. with higher levels of fluoride exposure. But the report found that nearly 2 million Americans have water that naturally contains at least 1.5 mg/L fluoride (the upper limit set by the World Health Organization) and 1 million Americans have tap water with naturally fluoride. of 2 mg/L or more. .

The report was also cited in a lawsuit filed against the Environmental Protection Agency by a nongovernmental organization and other plaintiffs. A federal court in California ruled in favor of the plaintiffs, who claimed that fluoride levels in U.S. drinking water pose a risk to human health.

Although the court ruling did not conclude that current levels of fluoride in water were dangerous to public health, the EPA must now strengthen its regulations for fluoride in drinking water due to “substantial and scientifically credible evidence establishing that fluoride represents a risk to human beings. health.”

Opponents of the decision, such as the American Academy of Pediatrics (AAP), have questioned the validity of the research highlighted in the case, specifically analyzing the NTP report on the link between fluoridated water and IQ.

“There is nothing in the current decision that will change my confidence in the safety of optimally fluoridated water in the US,” Charlotte W. Lewis, MD, MPH, FAAP, member of the AAP Section on Oral Health, said in a statement. “Water fluoridation is a public health policy based on a solid evidence base. “When new research is published, health experts review it to make sure it meets high standards of public safety.”

Fluoride and oral health

An established concern for exposure to high levels of fluoride in young children is dental fluorosis: too much fluoride while teeth are growing can cause tooth discoloration, including white specks, spots, or lines.

In the US, cases of dental fluorosis are mostly mild and cosmetic, meaning it does not affect the function of the teeth and is not painful. Children are no longer at risk for dental fluorosis around age 8, when the enamel on permanent teeth is fully formed.

Fluoride and other health problems

In his post on

While high levels of fluoride can weaken bones, in severe cases they cause a condition known as skeletal fluorosis.—bone cancer has not yet been reliably linked to fluoride exposure. A National Research Council review expressed concern about the risk of bone cancer based on preliminary research and animal studies, but Malin said there have been no rigorous studies in the United States on low exposure.

There has been some research that found a link between fluoride exposure and an increased risk of bone fracture, Malin said. Most studies tested higher levels of fluoride, but a recent Swedish study showed that fluoride exposure at levels similar to those in the US was associated with an increased risk of major osteoporosis and hip fracture among women postmenopausal Swedish women.

For arthritisIn general, studies on the association of fluoride with an increased risk of arthritis have not reached strong conclusions. A study of residents of Tongyu County in China found that excessive exposure to fluoridated water can increase osteoarthritis risk, but only at levels higher than the recommended 0.7 mg/L.

thyroid disease It also has to be strongly related to fluoride exposure. Malin said the association is plausible and a Canadian study found an increased risk of hypothyroidism in pregnant women with low levels of exposure to fluoride from drinking water, but more rigorous studies are needed in the US.

The National Sanitation Foundation has approved three chemicals for drinking water fluoridation: hydrofluosilicic acid, sodium fluorosilicate, and sodium fluoride. “These may be byproducts of phosphate fertilizer production,” Malin said, perhaps explaining what Kennedy meant when he called fluoride “industrial waste.”

Two of these fluoride additives have been found to contain heavy metals, Malin said. A 2014 study found arsenic, lead and aluminum in hydrofluorosilicic acid, and aluminum and barium in sodium fluoride, and noted that all samples tested contained a “surprising amount of aluminum.”

The study only used a few samples, but Malin also warned that these two chemicals can have a harmful effect when combined with disinfecting agents such as chlorine found in pipes.

“When combined, disinfecting agents can leach lead from lead-containing pipes into the community’s drinking water, and that can increase lead exposure,” Malin said. “People often think of it as medical-grade fluoride, or similar to natural fluoride, but these chemicals are, in my view, quite different.”

The most important and immediate impact would be a significant increase in tooth decay, especially among children.

“Water fluoridation is often referred to as a ‘public health miracle’ because it helps many people of all socioeconomic groups avoid the devastating effects of dental disease,” Zavras said. “Groups that consume high levels of carbohydrates will bear the burden of that increase disproportionately.”

However, Malin said there is evidence to suggest that water fluoridation is no longer essential for preventing cavities, as fluoridated toothpaste is widely available. “It appears that the demonstrated benefit has diminished over the years,” Malin added. “There is more evidence to support topical application.”

Fluoride recommendations have been modified previously. HHS initially set the optimal range for water fluoridation between 0.7 and 1.2 mg/L. In 2015, the agency updated its recommendation to the current optimal concentration of 0.7 mg/L due to increasing amounts of fluoride in foods processed with fluoridated water. “We need to remember that community drinking water is not the only source of fluoride exposure,” Malin added.

Whether Kennedy is in charge of American health initiatives or not, the EPA will have to address the health risks of water fluoridation under the federal court ruling.

“I think it makes sense to further regulate the chemical to mitigate the risk,” Malin said. “Whether that means reducing the concentration or eliminating it completely from the water supply remains to be determined.”