James Flanagin, the one dentist in Leslie, Ark., treats David Potts. About 25 million Individuals stay in dentist scarcity areas, based on new analysis from Harvard College.
Katie Adkins/KFF Well being Information
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Katie Adkins/KFF Well being Information
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 consuming water.
For its refusal, the Ozark Mountain Regional Public Water Authority has acquired a whole bunch 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 bunch of rural American communities that face a one-two punch to oral well being: a dire scarcity of dentists and a scarcity of fluoridated consuming water, which is extensively seen amongst dentists as one of the vital efficient instruments to stop tooth decay.
However because the anti-fluoride motion builds unprecedented momentum, it could end up that the Ozarks weren’t behind the occasions in any case.
“We’ll finally win,” Anderson mentioned. “We might be vindicated.”
Fluoride, a naturally occurring mineral, retains enamel robust when added to consuming water, based on the Facilities for Illness Management and Prevention and the American Dental Affiliation. However the anti-fluoride motion has been energized since authorities scientists printed a report final summer time discovering a attainable hyperlink between decrease IQ in kids and consuming quantities of fluoride which might be larger than what’s beneficial in American consuming 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 turn out to be the primary state to ban it in faucet water.
Division of Well being and Human Providers Secretary Robert F. Kennedy Jr., who has lengthy espoused fringe well being theories, has referred to as fluoride an “industrial waste” and “harmful neurotoxin” and mentioned the Trump administration will suggest or not it’s faraway from all public consuming water.
A storage tank in northern Arkansas holds water from the Ozark Mountain Regional Public Water Authority, which has defied a state regulation requiring fluoride to be added to consuming water for greater than a decade.
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Katie Adkins/KFF Well being Information
Individually, Republican efforts to increase tax cuts and shrink federal spending could squeeze Medicaid, which might deepen shortages of dentists in rural areas the place many residents depend upon the federal insurance coverage program for no matter dental care they’ll discover.
Dental specialists warn that the simultaneous erosion of Medicaid and fluoridation might exacerbate a disaster of rural oral well being and reverse a long time of progress in opposition to tooth decay, significantly for youngsters and those that hardly ever 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 large pillars of tips on how to preserve wholesome for a lifetime.”
Many already are.
Overlapping ‘dental deserts’ and fluoride-free zones
Practically 25 million Individuals stay in areas with out sufficient dentists — greater than twice as many as prior estimates by the federal authorities — based on 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 may be low, Elani mentioned.
The ADA has estimated that solely a 3rd of dentists deal with sufferers on Medicaid.
“I believe this case is way 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 need to 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, not less than 230 even have principally or utterly unfluoridated public consuming water, based on a KFF Well being Information evaluation of fluoride information printed by the CDC. Which means folks in these areas who cannot discover a dentist additionally don’t get safety for his or her enamel from their faucet water.
The KFF Well being Information evaluation doesn’t cowl your entire nation as a result of it doesn’t embrace non-public wells and 13 states don’t submit fluoride information 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 middle 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 court docket, then misplaced once more on attraction.
Anderson, who has chaired the water system’s board since 2007, mentioned he wish to problem the fluoride mandate in court docket once more and would argue the case himself if obligatory. In a cellphone interview, Anderson mentioned he believes that fluoride can hamper the mind and physique to the purpose of constructing folks “get fats and lazy.”
Close by within the tiny, no-stoplight group of Leslie, Ark., which will get water from the Ozark system, the one dentist on the town operates out of a one-man clinic tucked at the back of 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 will have extra decay in case your water just isn’t fluoridated. That is only a truth.”
James Flanagin, the one dentist within the tiny Arkansas city of Leslie, which additionally has unfluoridated consuming water, treats sufferers at the back of an vintage retailer on Major Road.
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Katie Adkins/KFF Well being Information
Fluoride’s public well being impacts
Fluoride was first added to public water in an American metropolis in 1945 and unfold to half of the U.S. inhabitants by 1980, based on the CDC. Due to “the dramatic decline” in cavities that adopted, in 1999 the CDC dubbed fluoridation as one among 10 nice public well being achievements of the twentieth century.
At the moment greater than 70% of the U.S. inhabitants on public water techniques get fluoridated water, with a beneficial focus of 0.7 milligrams per liter, or about three drops in a 55-gallon barrel, based on the CDC.
Fluoride can be current in fashionable toothpaste, mouthwash, dental varnish, and some meals and drinks — like raisins, potatoes, oatmeal, espresso, and black tea. However a number of dental specialists mentioned these merchandise don’t reliably attain as many low-income households as consuming water, which has a further profit over toothpaste of strengthening kids’s enamel 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 needed to maintain fluoride in public water provides, whereas 29% and 26% supported its removing.
Chelsea Fosse, an skilled on oral well being coverage on the American Academy of Pediatric Dentistry, mentioned she nervous 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 mix, she mentioned, could possibly 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 do not assist suppliers in finding and serving the highest-need populations, I actually do not know what we are going to do.”
A number of peer-reviewed research have proven what ending water fluoridation might appear to be. Previously few years, research of cities in Alaska and Canada have proven that communities that stopped fluoridation noticed vital will increase in kids’s cavities when put next with comparable cities that didn’t. A 2024 examine from Israel reported a “two-fold enhance” in dental remedies for youths 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 skilled 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 in opposition to America, Hayes mentioned, after which later fears arose of attainable hyperlinks to most cancers, which have been refuted by intensive 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 kids’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 might be larger than what’s current in American consuming water is related to decrease IQ in kids. The report was based mostly on an evaluation of 74 research carried out in different nations, most of which have been thought-about “low high quality” and concerned publicity of not less than 1.5 milligrams of fluoride per liter of water — or greater than twice the U.S. advice — based on this system.
Dentist James Flanagin operates out of a small clinic at the back of an vintage retailer in Leslie, Ark. Leslie is one among a whole bunch of American communities, principally rural, which have each a scarcity of dentists and unfluoridated consuming water.
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Katie Adkins/KFF Well being Information
The next month, in a long-simmering lawsuit filed by fluoride opponents, a federal decide in California mentioned the attainable 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 attraction this ruling within the remaining days of the Biden administration, however the Trump administration might 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 thus far between lowered IQ and the quantity of fluoride truly current in most Individuals’ water. The court docket ruling could immediate further analysis carried out within the U.S., Hayes mentioned, which she hoped would lastly put the marketing campaign in opposition to fluoride to relaxation.
“It is one of many nice mysteries of my profession, what sustains it,” Hayes mentioned. “What considerations me is that there is some perception amongst some members of the general public — and a few of our policymakers — that there’s some reality to this.”
Not all specialists have been so dismissive of the toxicology program’s report. Dr. Bruce Lanphear, a kids’s well being researcher at Simon Fraser College in Canada, 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 ladies and infants.”
“The people who find themselves proposing fluoridation have to now show it is protected,” Lanphear instructed NPR in January. “What the examine does, or ought to do, is shift the burden of proof.”
Cities and states rethink fluoride
At the least 14 states to date this 12 months have thought-about or are contemplating payments that will raise fluoride mandates or prohibit fluoride in consuming water altogether. In February, Utah lawmakers handed the nation’s first ban, which Republican Gov. Spencer Cox instructed ABC4 Utah he intends to signal. And each Florida Surgeon Basic Joseph Ladapo and Texas Agriculture Commissioner Sid Miller have referred to as for his or her respective states to finish fluoridation.
“I do not need Large Brother telling me what to do,” Miller instructed The Dallas Morning Information in February. “Authorities has pressured this on us for too lengthy.”
Moreover, dozens of cities and counties have determined to cease fluoridation up to now six months — together with not less than 16 communities in Florida with a mixed inhabitants of greater than 1.6 million — based on information studies 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 on a advice in opposition to fluoride.
“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 correct, Hayes mentioned, widespread decay can be seen inside years. Youngsters’ enamel will rot of their mouths, she mentioned, although “we all know tips on how to utterly stop it.”
“It is pointless ache and struggling,” Hayes mentioned. “If you happen to go into any kids’s hospital throughout this nation, you may see a ready checklist of children to get into the working room to get their enamel fastened as a result of they’ve extreme decay as a result of they have not had entry to both fluoridated water or different sorts of fluoride. Sadly, that is simply going to worsen.”
Dentist shortages and unfluoridated Water: Methodology
This KFF Well being Information article identifies communities with an elevated danger of tooth decay by combining information on areas with dentist shortages and unfluoridated consuming water. The 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 information particulars the populations served and fluoridation standing of greater than 38,000 public water techniques in 37 states. KFF Well being Information categorized 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 not less than half of the overall inhabitants of all water techniques based mostly in that county, even when these techniques reached past the county borders, which many do.
The evaluation recognized roughly 230 counties that meet these standards, which means they’ve each a dire scarcity of dentists and largely unfluoridated consuming water.
However this complete is definitely an undercount. 13 states don’t report water system information to the CDC, and the company information doesn’t embrace non-public wells, most of that are unfluoridated.
KFF Well being Information is a nationwide newsroom that produces in-depth journalism about well being points and is without doubt one of the core working packages at KFF.
