With Few Dentists and Fluoride Under Siege, Rural America Risks New Surge of Tooth Decay

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 regulation 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 lot of state fines amounting to about $130,000, that are stuffed in a cardboard field and left unpaid, mentioned Andy Anderson, who’s against fluoridation and has led the water system for practically twenty years.

This Ozark area is amongst a whole lot 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 broadly considered amongst dentists as one of the efficient instruments to forestall tooth decay. However because the anti-fluoride motion builds unprecedented momentum, it might prove that the Ozarks weren’t behind the occasions in spite of everything.

“We’ll finally win,” Anderson mentioned. “We will likely be vindicated.”

Fluoride, a naturally occurring mineral, retains tooth robust when added to ingesting water, in response to the Facilities for Illness Management and Prevention and the American Dental Affiliation. However the anti-fluoride motion has been energized since a authorities report final summer season discovered a doable hyperlink between decrease IQ in youngsters and consuming quantities of fluoride which are larger than what’s advisable in American ingesting water. Dozens of communities have determined to cease fluoridating in latest months, and state officers in Florida and Texas have urged their water techniques to do the identical. Utah is poised to grow to be the primary state to ban it in faucet water.

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 mentioned the Trump administration will suggest or not it’s faraway from all public ingesting water.

Individually, Republican efforts to increase tax cuts and shrink federal spending could squeeze Medicaid, which may deepen current shortages of dentists in rural areas the place many residents rely on the federal insurance coverage program for no matter dental care they’ll discover.

Dental consultants 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 youngsters and those that not often see a dentist.

“If in case you have of us with little entry to skilled care and no entry to water fluoridation,” mentioned Steven Levy, a dentist and main fluoride researcher on the College of Iowa, “then they’re lacking two of the massive pillars of easy methods to hold wholesome for a lifetime.”

Many already are.

Overlapping ‘Dental Deserts’ and Fluoride-Free Zones

Almost 25 million Individuals stay in areas with out sufficient dentists — greater than twice as many as prior estimates by the federal authorities — in response to a latest examine 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 examine, 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 might be low, Elani mentioned.

The ADA has estimated that solely a 3rd of dentists deal with sufferers on Medicaid.

“I think this case is far worse for Medicaid beneficiaries,” Elani mentioned. “If in case you have Medicaid and your nearest dentists don’t settle for it, then you’ll doubtless must go to the third, or fourth, or the fifth.”

The Harvard examine recognized over 780 counties the place greater than half of the residents stay in a scarcity space. Of these counties, at the least 230 even have principally or utterly unfluoridated public ingesting water, in response to a KFF evaluation of fluoride knowledge printed by the CDC. Meaning folks in these areas who can’t discover a dentist additionally don’t get safety for his or her tooth from their faucet water.

The KFF Well being Information evaluation doesn’t cowl the whole nation as a result of it doesn’t embody non-public wells and 13 states don’t submit fluoride knowledge 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 heart 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 courtroom, then misplaced once more on enchantment.

Anderson, who has chaired the water system’s board since 2007, mentioned he wish to problem the fluoride mandate in courtroom once more and would argue the case himself if mandatory. In a telephone interview, Anderson mentioned he believes that fluoride can hamper the mind and physique to the purpose of constructing folks “get fats and lazy.”

“So in the event you exit within the streets today, stroll down the streets, you’ll see numerous fats folks sporting their pajamas out in public,” he mentioned.

Close by within the tiny, no-stoplight group of Leslie, Arkansas, 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, mentioned 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 mentioned.

“There isn’t a doubt that there’s extra dental decay right here than there would in any other case be,” he mentioned. “You’ll have extra decay in case your water just isn’t fluoridated. That’s only a reality.”

Fluoride Seen as a Nice Public Well being Achievement

Fluoride was first added to public water in an American metropolis in 1945 and unfold to half of the U.S. inhabitants by 1980, in response to the CDC. Due to “the dramatic decline” in cavities that adopted, in 1999 the CDC dubbed fluoridation as one in all 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 advisable focus of 0.7 milligrams per liter, or about three drops in a 55-gallon barrel, in response to the CDC.

Fluoride can be current in fashionable toothpaste, mouthwash, dental varnish, and a few meals and drinks — like raisins, potatoes, oatmeal, espresso, and black tea. However a number of dental consultants mentioned these merchandise don’t reliably attain as many low-income households as ingesting water, which has a further profit over toothpaste of strengthening youngsters’s tooth from inside as they develop.

Two latest polls have discovered that the biggest share of Individuals assist 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 removing.

Chelsea Fosse, an knowledgeable on oral well being coverage on the American Academy of Pediatric Dentistry, mentioned she fearful 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 mentioned, might be “devastating.”

“Will probably be visibly obvious what this does to the prevalence of tooth decay,” Fosse mentioned. “If we eliminate water fluoridation, if we make Medicaid cuts, and if we don’t assist suppliers in finding and serving the highest-need populations, I actually don’t know what we are going to do.”

A number of peer-reviewed research have proven what ending water fluoridation may appear to be. Previously few years, research of cities in Alaska and Canada have proven that communities that stopped fluoridation noticed important will increase in youngsters’s cavities when put next with comparable cities that didn’t. A 2024 examine 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, mentioned Catherine Hayes, a Harvard dental knowledgeable 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 mentioned, after which later fears arose of doable hyperlinks to most cancers, which had been refuted by means of in depth scientific analysis. Within the ’80s, hysteria fueled fears of fluoride inflicting AIDS, which was “ludicrous,” Hayes mentioned.

Extra lately, the anti-fluoride motion seized on worldwide analysis that implies excessive ranges of fluoride can hinder youngsters’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 average confidence” that publicity to ranges of fluoride which are larger than what’s current in American ingesting water is related to decrease IQ in youngsters. The report was based mostly on an evaluation of 74 research carried out in different international locations, most of which had been thought-about “low high quality” and concerned publicity of at the least 1.5 milligrams of fluoride per liter of water — or greater than twice the U.S. advice — in response to this system.

The next month, in a long-simmering lawsuit filed by fluoride opponents, a federal decide in California mentioned the doable 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 enchantment this ruling within the ultimate 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 mentioned, no affiliation has been proven up to now between lowered IQ and the quantity of fluoride really current in most Individuals’ water. The courtroom ruling could immediate extra analysis carried out within the U.S., Hayes mentioned, which she hoped would lastly put the marketing campaign towards fluoride to relaxation.

“It’s one of many nice mysteries of my profession, what sustains it,” Hayes mentioned. “What issues me is that there’s some perception amongst some members of the general public — and a few of our policymakers — that there’s some reality to this.”

Not all consultants had been so dismissive of the toxicology program’s report. Bruce Lanphear, a youngsters’s well being researcher at Simon Fraser College in British Columbia, printed an editorial in January that mentioned 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’s protected,” Lanphear informed NPR in January. “That’s what this examine does. It shifts the burden of proof — or it ought to.”

Cities and States Rethink Fluoride

Not less than 14 states to date this yr have thought-about or are contemplating payments that may elevate fluoride mandates or prohibit fluoride in ingesting water altogether. In February, Utah lawmakers handed the nation’s first ban, which Republican Gov. Spencer Cox informed 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 don’t need Large Brother telling me what to do,” Miller informed 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 prior to now six months — together with at the least 16 communities in Florida with a mixed inhabitants of greater than 1.6 million — in response to information experiences and the Fluoride Motion Community, an anti-fluoride group.

Stuart Cooper, govt director of that group, mentioned the motion’s unprecedented momentum can be additional supercharged if Kennedy and the Trump administration comply with by means of on a advice towards fluoride.

Cooper predicted that almost all U.S. communities can have stopped fluoridating inside years.

“I feel what you’re seeing in Florida, the place each group is falling like dominoes, goes to now occur in the US,” he mentioned. “I feel we’re seeing absolutely the finish of it.”

If Cooper’s prediction is true, Hayes mentioned, widespread decay can be seen inside years. Children’ tooth will rot of their mouths, she mentioned, despite the fact that “we all know easy methods to utterly forestall it.”

“It’s pointless ache and struggling,” Hayes mentioned. “When you go into any youngsters’s hospital throughout this nation, you’ll see a ready checklist of children to get into the working room to get their tooth fastened as a result of they’ve extreme decay as a result of they haven’t had entry to both fluoridated water or different kinds of fluoride. Sadly, that’s simply going to worsen.”

Methodology: How We Counted

This KFF Well being Information article identifies communities with an elevated danger of tooth decay by combining knowledge on areas with dentist shortages and unfluoridated ingesting water. Our 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 almost 25 million Individuals stay in dentist-shortage areas that span a lot of rural America. The CDC knowledge particulars the populations served and fluoridation standing of greater than 38,000 public water techniques in 37 states. We labeled counties as having elevated danger of tooth decay in the event that they met three standards:Greater than half of the residents stay 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 at the least half of the whole inhabitants of all water techniques based mostly in that county, even when these techniques reached past the county borders, which many do.

Our 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 knowledge to the CDC, and the company knowledge doesn’t embody non-public wells, most of that are unfluoridated.

KFF Well being Information knowledge editor Holly Okay. Hacker contributed to this text.