Major shifts in public health policy can bring unforeseen consequences. But in the case of fluoride bans, we already know what the consequences will be: higher costs of dental care, and higher rates of tooth decay — especially among children.

This is particularly alarming because dental care is already increasingly unaffordable and out of reach for millions of Americans. The latest data shows that 72 million Americans lack dental insurance. Medicare does not cover dental services, and Medicaid only guarantees dental coverage for children — adult dental coverage varies by state. Millions of the lucky people who do get dental insurance through Medicaid are expected to lose coverage after Congress and the president approved a budget that will strip nearly $1 trillion and 10 million enrollees from Medicaid. 

Without preventive measures and care, problems go untreated until they become emergencies. In 2022 alone, Americans made about 1.6 million dental-related visits to hospital emergency departments, costing the health care system $3.9 billion. That’s up more than $500 million from 2019. And visits have increased the most — nearly 60% — for children under 14.

Fluoride is an especially critical prevention tool for families who cannot access or afford dental care. Yet the Department of Health and Human Services and its agencies have made it clear that they intend to dismantle the protection that fluoride provides, too. After announcing plans to reverse the Centers for Disease Control and Prevention’s guidance on water fluoridation earlier this year, HHS and the Food and Drug Administration are now moving to end the use of fluoride supplements — an important tool for preventing tooth decay among children and high-risk adults, especially in communities without water fluoridation. On top of that, HHS has eliminated the CDC’s Division of Oral Health, the Health Resources and Services Administration’s chief dental officer, and oral health research funding and staff at the National Institutes of Health.

The anti-fluoride movement is out of step with the overwhelming consensus of more than 7,000 studies that shows fluoride is safe and effective at recommended levels — and with the American people. A recent national poll from CareQuest Institute for Oral Health, where I work, showed that the vast majority of Americans (81%) either support community water fluoridation (52%) or have no opinion on it (29%). In fact, only 6% of respondents said that they support banning fluoride in all communities.

I’m a dentist from India. The fluoride debate in the U.S. horrifies me

Despite the American people’s support for fluoridation, misinformation about fluoride continues to cause fear and confusion among the public and threatens to turn back the clock on oral health. The consequences can be graver than an extra filling or two.

Back in 1966, Hawaii’s government vetoed a measure to include fluoride in the water. A 2015 report found that the state had the highest rate of tooth decay among children in the nation. It continues to have some of the worst oral health outcomes in the country. In Juneau, Alaska, dental treatment costs for children spiked after fluoridation ended — and for kids 6 and under, they more than doubled, rising from about $273 to $645 per child each year. In Calgary, Canada, which ended fluoridation in 2011, antibiotic use for serious dental infections in young children spiked 700% — from 16 to 128 per year, according to data presented at a city council meeting — before the city restored fluoride in 2024, taking steps to reverse years of preventable harm.

The problem is not only medical, it’s financial. Nationwide, the CDC estimates that community water fluoridation prevents 25% of cavities and saves $6.5 billion in dental costs each year — and likely prevents millions of school and work hours lost to dental problems.

Without a concerted effort to increase access to preventive dental care, we can expect similar outcomes to what we saw in Hawaii, Juneau, and Calgary. And dental problems in childhood don’t end with baby teeth — they set the stage for adult cavities and a lifetime of chronic health problems linked to poor oral health.

The removal of access to fluoride, coupled with Congress’ cuts to Medicaid, will strip away vital protections for those most at risk.

We need the administration to step up on policy solutions that can reverse this oral health crisis.

First, the administration should review the weight of the evidence and studies of U.S. communities on water fluoridation and fluoride supplements, and delay any action that would restrict access to fluoride until it can prove that U.S. practices cause any harm.


Safety of fluoride supplements, and freedom of choice, debated at FDA meeting

Second, HHS and the new Administration for a Healthy America must integrate oral health care investments into its broader public health initiatives. As part of that, it should continue the oral health prevention work and data collection from the CDC’s former Division of Oral Health, as well as critical oral health research at the NIH.

Third, the Centers for Medicare and Medicaid Services should make every effort to ensure that new provisions from the One Big Beautiful Bill Act, such as Medicaid work reporting requirements, are implemented slowly and carefully in ways that minimize unnecessary coverage losses.  

America’s oral health crisis is the result of decades of underinvestment and a system that treats oral health as separate from overall health. Now, we have an urgent choice to make: Will we slide backward? Or we will we finally stand up for prevention and access to quality dental care to combat this country’s growing oral health crisis?

For those who are truly committed to America’s oral and overall health, the answer is clear.

Melissa Burroughs is senior director of public policy at the CareQuest Institute for Oral Health.