by James V. Talano, MD, MBA, FACC
In February 2024, the Collier County Board of Commissioners unanimously voted to discontinue the addition of fluoride to the county’s public water supply, a practice that had been in place since 1985. The decision, driven by concerns over “health freedom” and individual choice, has sparked considerable debate within the community. This past December, the City of Naples with a 4-3 vote decided to do the same.
The fluoridation of public drinking water began in the mid-20th century as a public health initiative to combat tooth decay. Since its inception, the practice has been celebrated as a breakthrough in preventive health but also criticized for potential risks. As a resident and medical professional in Naples, Florida, I fully agree in the importance of reassessing the relevance of this policy in light of modern scientific, ethical, and societal considerations. I would argue however that any change in policy must include a comprehensive plan to measure its impacts on public health and community well-being.
Fluoride is a naturally occurring mineral that strengthens tooth enamel and helps prevent cavities. Research consistently shows that fluoridation reduces tooth decay by approximately 25% across all age groups, according to the Centers for Disease Control and Prevention (CDC). The practice is endorsed by decades of data from public health organizations worldwide, including the World Health Organization (WHO).
However, studies also demonstrate that areas discontinuing water fluoridation often experience a marked increase in dental decay, particularly among children. For instance, Calgary, Canada, ceased fluoridation in 2011. A subsequent study published in the Canadian Journal of Public Health revealed that children in Calgary experienced a significant rise in cavities compared to children in Edmonton, a city that continued fluoridation. In response, Calgary voted to resume fluoridation to address the growing public health concern. Similar trends were observed in Juneau, Alaska, which ended fluoridation in 2007 and subsequently saw an increase in dental issues.
While the benefits of fluoride are clear, recent studies have reignited concerns about potential risks. For example, a 2023 study in JAMA Network Open found an association between higher prenatal fluoride exposure and increased neurobehavioral problems in children. The National Toxicology Program similarly noted “moderate confidence” in a potential link between high fluoride exposure and lower IQ in children, though these studies often pertain to fluoride levels significantly higher than the recommended U.S. level of 0.7 milligrams per liter.
The ethical dimension of water fluoridation has also been a focal point in Collier County. Critics argue that adding fluoride to public water supplies constitutes mass medication without informed consent. With the widespread availability of alternatives such as fluoride toothpaste and professional dental treatments, some residents question whether fluoridation remains necessary, especially as bottled and filtered water use grows.
As Collier County moves forward, it is critical to monitor the effects of this decision on dental health outcomes, particularly among vulnerable populations. Evidence from other regions suggests that removing fluoride can lead to increased rates of cavities and dental decay, disproportionately impacting children and low-income residents. A robust plan to measure these impacts and implement alternative fluoride strategies, if needed, will be essential to ensure public health goals are met.
The debate over fluoridation reflects broader tensions between public health initiatives and individual rights. While the benefits of fluoride in reducing dental decay are well-documented, evolving science and societal trends compel us to reexamine its application. By committing to informed, evidence-based decisions and ongoing evaluation, Collier County can navigate this complex issue in a way that serves the best interests of its residents.
James V. Talano, MD, MBA, FACC, is the Director of SWICFT Cardiovascular Institute in Naples, Florida, and a Professor of Clinical Medicine at Loyola and Central Florida Schools of Medicine.
References:
- Fluoridation Cessation and Children’s Dental Caries: A 7-Year Follow-Up Evaluation of Grade 2 Schoolchildren in Calgary and Edmonton, Canada
This study found that the cessation of water fluoridation in Calgary was associated with an increase in dental caries among children. https://pubmed.ncbi.nlm.nih.gov/34309045/ - Maternal Urinary Fluoride and Child Neurobehavior at Age 36 Months
Published in JAMA Network Open, this study found that prenatal fluoride exposure was associated with increased risk for neurobehavioral problems among children residing in areas with optimally fluoridated water. https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2818858