States debate the future of community water fluoridation

Some local ballots include fluoridation-related measures

With election season quickly approaching, for certain communities the future of fluoride in water is unclear. Some states have ballot measures on water fluoridation to be voted on this year, and other states are considering fluoride-related legislation that could produce changes in the coming years. 

Opponents of fluoride in water say it brings a host of potential safety and ethics concerns, while supporters, including most dental professionals, cite the peer-reviewed scientific evidence that supports fluoridation as a health-promoting measure.

Here is an overview of what’s going on in some locations throughout the country when it comes to this public health benefit many communities have utilized for decades and others have not — or are debating removing.

Local:

There will be a ballot measure in Rutland City, Vermont, where voters will decide whether or not to keep fluoride in the city’s water supply. Opponents of water fluoridation collected enough signatures in support of a referendum that it will appear on the city’s Town Meeting Day ballot March 5. If it passes, the initiative will remove fluoridation from the city’s water, which has been in effect since 1983. This is not the first time the issue has come before voters; the town previously voted against stopping water fluoridation in 2016.

The city council in Lebanon, Oregon, approved a motion in December 2023 that would add the question to the city’s November general election ballot of whether to remove fluoride from the surface water treatment process. The motion, which passed on a 4-2 vote, follows previous petition efforts by city residents that did not have enough momentum. Lebanon has included fluoride in its water supply since 2001.

State:

Some Kentucky lawmakers have proposed a bill that would permit local municipalities and water districts to stop fluoridating their water if they choose. Current law requires the state to establish, maintain, monitor and enforce water fluoridation programs. Under the new law, water systems that are currently operating would continue until their governing body votes to end its participation. Although the bill’s sponsor, Rep. Mark Hart, R-Ky., has proposed the measure in the past, this is the first time it received a committee hearing. The bill passed the state House committee on a 16-1 vote.

A proposed senate bill in Georgia would remove the state’s authority to require fluoridation and instead offer the option for communities to choose whether or not they want community water fluoridation. It would also remove the 1 ppm limit on fluoridation and the tax deduction allowed for those with an allergy to fluoride. Currently, the state has authority to require community water fluoridation unless a community removes itself from the requirement by referendum.

Beginning in 2025, a Nebraska bill would make changes to existing local control laws relative to community water fluoridation. While current law requires fluoridation of water in towns of more than 1,000 unless there is a vote to stop it, the bill would alter that arrangement by dictating that towns of any size must first adopt an ordinance in order to continue fluoridating. Anything short of ordinance adoption requires fluoridation to end. The bill also dictates that town officials overriding voters’ rejection of fluoridation would require a two-thirds vote but only a simple majority to repeal voters’ referendums favoring fluoridation. It passed the Health and Human Services committee but was not voted on by the full chamber, meaning that it will likely reappear next session.

A proposed amendment to Missouri’s early notification law would fortify the existing requirement that water systems provide prior notice when modifying their fluoridation operations. Current law requires water systems to publicize proposed fluoridation changes at least 90 days prior to any vote. The new law would add that, prior to publicizing the plan to vote, water systems that intend to start or stop water fluoridation must seek and receive local health departments’ information on fluoride’s impact on public health.

The New Jersey Public Water Supply Fluoridation Act, which was introduced in the Senate in January and referred to the Senate Environment and Energy Committee, would require the fluoridation of water supplied by public community water systems. If approved, the commissioner of environmental protection would require the fluoridation of water in all public community water systems within 12 months of the bill’s effective date.

In North Carolina, a proposed bill would require a review of the National Toxicology Program Monograph to determine if there is sufficient evidence for a link between fluoride in the public water supply and cognitive decline or any other neurological detriment in children. The NTP Monograph includes evaluations of the evidence that environmental substances are associated with noncancer health effects. The NTP report has not yet been approved for final release. The National Academies of Science, Engineering and Medicine twice sent the monograph back for review because of questions on whether the science supported the proposed claims. Currently, a panel is reviewing the report again before a final release.

For more information about fluoride, visit the ADA’s topic page at https://www.ada.org/resources/community-initiatives/fluoride-in-water/fluoridation-faqs.