The US Raises Concerns About Fluoride in Drinking Water – What’s the Situation in the UK? | UK News

The discussion about the addition of fluoride to tap water is not a recent phenomenon.

This initiative, which aims to decrease tooth decay, has been in practice for 60 years.

However, since fluoride toothpaste became widely accessible in the 1970s, the necessity of adding it to the public water supply has come under scrutiny.

Recently, the topic has resurfaced in public discourse, especially following Donald Trump’s selection of Robert F Kennedy Jr as his health secretary, who has pledged to eliminate it.

Although RFK is known for his controversial public health opinions, the debate over fluoridation remains significant.

Research in the US has associated fluoride with a decline in children’s IQ, and a UK study has raised questions regarding its overall efficacy in water.

So, what exactly is fluoride, what do experts opine on it, and what’s the situation in the UK?

What is fluoride and what does it do?

Fluoride is a naturally occurring mineral found in rocks, which seeps into the soil, rivers, and lakes.

According to the Oral Health Foundation, it enhances dental health by fortifying tooth enamel, making it more resistant to decay, and it also lessens the amount of acid produced by bacteria in the mouth.

Fluoride is especially beneficial for children’s teeth, as previous research indicates that ingesting it during tooth development may enhance enamel’s resistance to later acid erosion and subsequent decay.

Dr. Kunal Patel, a dentist with both private and NHS experience spanning 15 years, emphasized to Sky News that the significance of fluoride is thoroughly ingrained in dental education, highlighting the “scientifically proven advantages” of including fluoride in oral hygiene routines.

He describes fluoride as a passive protective method for teeth.

“If you opt out of using fluoride, your brushing, flossing, and other cleaning techniques must be exceptionally effective,” he adds.

How do we obtain fluoride?

Virtually all water naturally contains some fluoride, but typically not enough to effectively prevent decay.

In certain regions, the fluoride levels in water supplies may be naturally elevated, a topic we will explore later.

We also acquire trace amounts of fluoride from many foods and drinks, with brewed tea being a significant source due to tea plants absorbing fluoride from the soil.

Most toothpaste now incorporates fluoride to enhance protection against decay.

When did the addition of fluoride to water supplies begin?

Numerous oral health experts recommend adding fluoride to water—termed fluoridation—as one of the most effective approaches to collectively mitigate dental issues, particularly in underserved communities.

This practice commenced in 1945 in Grand Rapids, Michigan, after research indicated that individuals in areas with naturally higher fluoride levels experienced less tooth decay.

Fluoride was first introduced to the water supply in England in 1964 during a pilot project in Birmingham.

Over the years, it has been implemented for about 75% of the US population, contrasting with approximately 10% in England.

The World Health Organization (WHO) estimates that around 400 million people in 25 countries have access to artificially fluoridated water, while about 50 million have naturally occurring fluoride at levels comparable to artificial systems.

What is the optimal fluoride level in water?

The WHO advises a maximum fluoride level of 1.5mg per litre.

This recommendation aims to strike a balance between minimizing tooth decay and mitigating the risks of dental and skeletal fluorosis.

Dental fluorosis is a frequent cosmetic issue resulting from excessive fluoride intake during tooth development, leading to the appearance of white spots or lines on the teeth.

Skeletal fluorosis, which is much rarer, manifests as a chronic disease affecting bones and joints due to ingesting high amounts of fluoride.

The UK government targets fluoride levels of 1mg per litre in drinking water, while the fluoride concentration is about 0.7mg per litre in the US.

Concerns regarding fluoride’s impact on children’s IQ

Fluoridation has been a contentious topic in the US, with over 100 lawsuits attempting to halt it, all without success, according to the American Fluoridation Society, an advocacy organization.

The anti-fluoride group Fluoride Action Network notes that over 150 towns and counties across the US have decided against public water fluoridation or have ceased its addition.

Opposition intensified earlier this year when a US government report indicated that fluoride levels in drinking water exceeding twice the recommended limit were associated with lower IQs in children.

This report, based on an analysis of existing research, stated its findings were made “with moderate confidence.”

It cited a 2019 study published in the esteemed journal JAMA Pediatrics, which concluded that IQ levels in three and four-year-olds were somewhat lower when their mothers had higher fluoride levels measured in their urine during pregnancy.

A federal judge in California referenced this report in September, ordering the Environmental Protection Agency (EPA) to enhance regulations on fluoridation, noting that current levels pose an unreasonable risk to children.

The judge clarified that he was not definitively stating that fluoridated water jeopardizes public health, but that it presents a risk.

Uncertainty over fluoride’s effectiveness

In the UK, while the government is contemplating plans to increase fluoride levels for millions and extend it to more regions, a significant review suggests that fluoridation may offer merely a “modest” benefit.

Academics at Manchester, Dundee, and Aberdeen universities examined 157 studies regarding the consequences of fluoridation on community dental health.

According to researchers, when the government first added fluoride to tap water, the average number of decayed, missing, or filled teeth among children was reduced by two whole teeth during their early development.

However, with the widespread availability of fluoride toothpaste, that figure has since declined.

Currently, it equates to an average reduction of merely “a quarter of a tooth” that is decayed, missing, or filled.

“Water fluoridation now only contributes a modest improvement in dental caries, and any benefits can take years to manifest,” remarked Professor Anne-Marie Glenny from the University of Manchester, a co-author of the study.

Is a ban on fluoride possible in the US?

Mr. Kennedy Jr has claimed that Mr. Trump intends to advocate for the removal of fluoride from drinking water on his initial day in office, referring to it as “industrial waste” in a statement on X.

He further asserted that fluoride is linked to a range of health issues including arthritis, bone fractures, bone cancer, neurodevelopmental disorders, and thyroid diseases.

While some research pertains to these assertions, none have definitively proven them.

Following these statements, Mr. Trump informed Sky News’ US affiliate NBC News that even though he had yet to discuss seizing fluoride with his health secretary, “it sounds okay to me. You know, it’s possible.”

The decision about adding fluoride to water is ultimately determined by state and local health authorities. Thus, Mr. Trump’s administration can only offer guidance on discontinuing its use.

‘It’s about risk versus benefit’

Stephen Peckham, a health policy professor at the University of Kent, previously led a study examining the potential associations between fluoridation and hypothyroidism—a condition characterized by an underactive thyroid—and is currently part of a research team probing the potential links between fluoride and IQ challenges within the UK population.

He stated to Sky News that while fluoride can have advantages, it is not essential, especially in water form.

“We recognize that consumed fluoride does not effectively prevent tooth decay,” he notes. “If fluoride is desired, it should be used topically on teeth, not ingested.”

He emphasizes that, despite fluoride’s limited benefits, the IQ study conducted in the US necessitates caution.

“We know that ingestion of fluoride can have neurotoxic effects. What remains uncertain is the specific fluoride level at which that begins.”

“The judge suggests that perhaps we should exercise greater caution by limiting access to fluoridated water for pregnant women.”

“Your maximum fluoride intake will depend on your consumption patterns. The more you drink, the more fluoride is ingested.”

It ultimately revolves around assessing the “balance of risk and benefit,” he explains.

“If the benefits are minimal, should there even be risks? The answer is no, there shouldn’t be.”

‘Focus on the most vulnerable communities’

Dr. Kunal Patel, who oversees six private dental clinics in Surrey, including one exclusively for children, mentioned that fluoridation was beneficial in a time of lower educational access and limited fluoride-containing toothpaste.

Before the IQ study surfaced, he would have supported fluoride expansion throughout any UK locality, believing “everyone could benefit” without adverse consequences.

Now, however, he advocates for a more “selective” approach, suggesting that fluoridation should be reserved “for regions experiencing dental health challenges, especially rural and deprived areas.”

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He cites areas in the North West as examples, mentioning a recent charity initiative aimed at promoting dental health among youth, where he found it “alarming” to discover many didn’t even possess a toothbrush.

He believes that it would be “wise” to extend similar initiatives to other poorly served regions in the UK, emphasizing that distributing toothpaste to local schools and enhancing dental care education could be even more effective.

“Education should be prioritized over fluoridated water,” he concludes.

A spokesperson from the Department of Health and Social Care remarked to Sky News: “The leading cause of hospital visits for children aged six to ten is the removal of decayed teeth.”

“Fluoridation at the permitted levels in this country is a secure and effective measure for public health that curtails tooth decay.”

“Prevention is always superior to treatment, and this government is dedicated to maintaining public health and reducing hospital admissions for children.”

Is your water fluoridated?

Approximately 330,000 individuals reside in areas of England with naturally occurring fluoride in their drinking water, while around 5.8 million receive an artificial supply.

This indicates that approximately 10% of the population in England resides in regions where fluoride is added to water, predominantly in the West Midlands and North East.

No fluoridation occurs in Wales, Scotland, or Northern Ireland.

Below is a full list of areas receiving artificial fluoridation in England, as per the British Fluoridation Society:

• Cumbria – 120,000
• Cheshire – 137,000
• Tyneside – 643,000
• Northumbria – 101,000
• County Durham – 85,000
• Humberside – 136,000
• Lincolnshire – 250,000
• Nottinghamshire – 287,000
• Derbyshire – 43,000
• Birmingham – 1,000,000
• Solihull – 200,000
• Coventry – 300,000
• Sandwell – 300,000
• Dudley – 305,000
• Walsall – 253,000
• Wolverhampton – 236,000
• Staffordshire – 497,000
• Shropshire – 22,000
• Warwickshire – 431,000
• Worcestershire – 253,000
• Bedfordshire – 198,000

Here’s a list of areas with the “optimal” natural fluoride levels:

• Hartlepool, County Durham – 89,000
• Easington, County Durham – 47,000
• Uttoxeter, Staffordshire – 13,000
• Redbridge, London Borough – 180,000

Where else could fluoride be introduced into water?

The Conservative government has put forth proposals to expand fluoridation initiatives throughout the North East, aiming to address the significant and enduring inequalities in the region’s dental health.

A public consultation regarding these plans was conducted in June and concluded in July. Since Labour leader Sir Keir Starmer’s government took over, the status of these proposals remains uncertain.

These are the regions that the government has proposed extending the fluoride supply to:

• Darlington
• Durham
• Gateshead
• Hartlepool
• Middlesbrough
• Newcastle
• Northumberland
• North Tyneside
• Redcar and Cleveland
• South Tyneside
• Stockton
• Sunderland