Fluoride Ban Impact: Rising Tooth Decay and Dental Costs

Fluoride ban could impact tooth decay rates and dental costs among children.

Fluoride is a widely recognized effective agent in preventing tooth decay and promoting oral health in children. However, recent studies have raised concerns about the potential impact of excessive fluoride exposure on children's IQ scores. The addition of fluoride to public water systems has been a cornerstone of oral health policy in the US since 1945. A recent study suggests that removing fluoride would have significant negative consequences for children's dental health, especially for those without private insurance ().

Fluoride: A Key Player in Reducing Tooth Decay

"Fluoride replaces weaker ions within tooth enamel, making it stronger and less susceptible to tooth decay caused by bacteria," said senior author Lisa Simon MD, DMD, Division of General Internal Medicine at Brigham and Women’s Hospital, a founding member of the Mass General Brigham healthcare system. “There’s strong evidence from other countries and cities, such as Calgary in Canada, showing that when fluoride is eliminated, dental disease increases. Our study offers a window into what would happen in the United States if water fluoridation ceased.

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A U.S. #fluoride ban could lead to decay in 25.4 million more teeth-the equivalent of one decayed tooth for every 1 in 3 children. #toothdecay #oralhealth #dentalhealth #dentalcosts

Simon and the research team focused on children for the study, because fluoride strengthens teeth during development, and more robust data links fluoridated water to oral health in this age group.

The study used detailed oral health and water fluoridation data collected from 8,484 children (ages 0-19, 49% girls) in the nationally representative National Health and Nutrition Examination Survey (NHANES). Using this dataset, the researchers developed a microsimulation model to see how banning fluoride from drinking water would impact oral health, quality of life and dental care costs.

The researchers simulated two scenarios over 5- and 10-year periods, which align with policy planning horizons. First, maintaining current fluoride levels, and second, eliminating the addition of fluoride to public water.

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"Using a simulation model to track the progression of diseases in current populations, we estimated the impact of removing fluoride on the risk of tooth decay and the related dental care costs, including treatment for decay and complications from delayed treatment. We ran the simulation 1,000 times to see how different factors could affect the results. This approach helps ensure that our predictions are more reliable and reflective of real-world variability,” said first author Sung Eun Choi, PhD, assistant professor of Oral Health Policy & Epidemiology at Harvard School of Dental Medicine.

The researchers found that eliminating fluoride increased the total number of decayed teeth by 7.5 percentage points, or 25.4 million more teeth with tooth decay over five years (equivalent to a tooth for one out of every three American children). The number of fluorosis cases—a discoloring of tooth enamel due to excessive fluoride intake—decreased by 0.2 million. They also estimated a cost of $9.8 billion in additional dental care costs over five years, which rose to $19.4 billion after 10 years.

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“Most of the increased cost could be attributed to publicly insured children, meaning it would be a direct public health cost,” said Simon.

The study did not model cognitive effects from fluoride exposure as current levels of fluoride in public water are not associated with worse neurobehavioral outcomes. The researchers note that their model demonstrates meaningful, ongoing benefit from fluoride at safe levels currently recommended by the Environmental Protection Agency, the National Toxicity Program, and the Centers for Disease Control and Prevention.

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“We know fluoride works. We’re able to show just how much it works for most communities and how much people stand to lose if we get rid of it,” said Simon.

Decay Doesn't Stand a Chance with Fluoride
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