100 l © 2025 American Dental Association
Section 4: Public Policy
Of the small faction that opposes water fluoridation for philosophical reasons, freedom of choice is one
of the most frequently cited issues.444 People take the stance that society should not “force” individuals
to act in ways that are beneficial to their own health or the health of others. They are opposed to
“government interference” in their lives.444 Some individuals are opposed to community action on any
health issue, others are opposed due to environmental or economic concerns, and some are opposed
because they are simply misinformed.444
Opposition to fluoridation has existed since the initiation of the first programs in 1945 and continues
today despite more than 80 years of practical experience showing fluoridation to be safe and effective.
An article that appeared in the local newspaper shortly after the first fluoridation program was
implemented in Grand Rapids, Michigan, noted that the fluoridation program was slated to commence
January 1, but did not actually begin until January 25.7 Interestingly, health officials in Grand Rapids began
receiving complaints of physical ailments, including “teeth falling out and enamel peeling off their teeth,”
attributed to fluoridation from citizens weeks before fluoride was actually added to the water.445
In 1992, a community in Finland opted to stop their fluoridation program at the end of the year in
December.446 However, it was discontinued at the end of November without the public being told.
Public surveys conducted in November and December and again in March the following year revealed
the occurrence and mean number of symptoms (the most common being itching and dryness of skin)
were fairly similar during the periods of actual and supposed fluoridation, indicating the symptoms
were not caused by fluoride in the water. Interestingly, those who claimed to be able to taste the fluoride
in the water made this claim equally often during actual and supposed fluoridation. A significant reduction
in the symptoms occurred after those responding to the surveys became aware that fluoridation had
stopped. The authors concluded that the prevalence rates of the symptoms were connected to the
psychological rather than physical effects of exposure to fluoride in water.446
Over time, leaders and organizations that opposed fluoridation have come and gone, but their basic
beliefs have remained the same. These beliefs include that fluoride is toxic and causes numerous
harmful health effects fluoride does not prevent tooth decay fluoridation is costly and fluoridation
interferes with freedom of choice and infringes on individual rights.
Opposition to water fluoridation is often fueled by criticism that its efficacy in preventing tooth
decay has never been subjected to the rigor of a randomized controlled trial (RCT). This changed in
2022 with the initiation of an RCT of fluoridated bottled water.447 The “waterBEST” research study448
is a phase 2b proof-of-concept, randomized, quadruple-masked, placebo-controlled, parallel group
trial designed to estimate the efficacy of fluoridated versus non-fluoridated bottled water for the
prevention of dental caries in 4-year-olds. As of 2024, the study had completed enrollment of 200
families with newborn children living in Lenoir and Wayne Counties in North Carolina, with follow-up
planned through 2028. The study is being conducted by researchers led by Dr. Gary Slade from the
Adams School of Dentistry at the University of North Carolina at Chapel Hill with funding from the
NIH/National Institute of Dental and Craniofacial Research. It is registered at ClinicalTrials.com164 and
the study protocol447 has been published by Sanders et al. (2024).
Opinions are seldom unanimous on any scientific subject. In fact, there really is no such thing as “final
knowledge” because new information is continuously emerging and being disseminated. As such, the
evidence for benefits must be continually weighed against evidence of risks. Health professionals,
decision-makers, and the public should be cooperating partners in the quest for accountability where
decisions are based on demonstrated benefits measured against verified risks.449 Dentists are a valuable
source of accurate information regarding water fluoridation for their patients and their communities.
Section 4: Public Policy
Of the small faction that opposes water fluoridation for philosophical reasons, freedom of choice is one
of the most frequently cited issues.444 People take the stance that society should not “force” individuals
to act in ways that are beneficial to their own health or the health of others. They are opposed to
“government interference” in their lives.444 Some individuals are opposed to community action on any
health issue, others are opposed due to environmental or economic concerns, and some are opposed
because they are simply misinformed.444
Opposition to fluoridation has existed since the initiation of the first programs in 1945 and continues
today despite more than 80 years of practical experience showing fluoridation to be safe and effective.
An article that appeared in the local newspaper shortly after the first fluoridation program was
implemented in Grand Rapids, Michigan, noted that the fluoridation program was slated to commence
January 1, but did not actually begin until January 25.7 Interestingly, health officials in Grand Rapids began
receiving complaints of physical ailments, including “teeth falling out and enamel peeling off their teeth,”
attributed to fluoridation from citizens weeks before fluoride was actually added to the water.445
In 1992, a community in Finland opted to stop their fluoridation program at the end of the year in
December.446 However, it was discontinued at the end of November without the public being told.
Public surveys conducted in November and December and again in March the following year revealed
the occurrence and mean number of symptoms (the most common being itching and dryness of skin)
were fairly similar during the periods of actual and supposed fluoridation, indicating the symptoms
were not caused by fluoride in the water. Interestingly, those who claimed to be able to taste the fluoride
in the water made this claim equally often during actual and supposed fluoridation. A significant reduction
in the symptoms occurred after those responding to the surveys became aware that fluoridation had
stopped. The authors concluded that the prevalence rates of the symptoms were connected to the
psychological rather than physical effects of exposure to fluoride in water.446
Over time, leaders and organizations that opposed fluoridation have come and gone, but their basic
beliefs have remained the same. These beliefs include that fluoride is toxic and causes numerous
harmful health effects fluoride does not prevent tooth decay fluoridation is costly and fluoridation
interferes with freedom of choice and infringes on individual rights.
Opposition to water fluoridation is often fueled by criticism that its efficacy in preventing tooth
decay has never been subjected to the rigor of a randomized controlled trial (RCT). This changed in
2022 with the initiation of an RCT of fluoridated bottled water.447 The “waterBEST” research study448
is a phase 2b proof-of-concept, randomized, quadruple-masked, placebo-controlled, parallel group
trial designed to estimate the efficacy of fluoridated versus non-fluoridated bottled water for the
prevention of dental caries in 4-year-olds. As of 2024, the study had completed enrollment of 200
families with newborn children living in Lenoir and Wayne Counties in North Carolina, with follow-up
planned through 2028. The study is being conducted by researchers led by Dr. Gary Slade from the
Adams School of Dentistry at the University of North Carolina at Chapel Hill with funding from the
NIH/National Institute of Dental and Craniofacial Research. It is registered at ClinicalTrials.com164 and
the study protocol447 has been published by Sanders et al. (2024).
Opinions are seldom unanimous on any scientific subject. In fact, there really is no such thing as “final
knowledge” because new information is continuously emerging and being disseminated. As such, the
evidence for benefits must be continually weighed against evidence of risks. Health professionals,
decision-makers, and the public should be cooperating partners in the quest for accountability where
decisions are based on demonstrated benefits measured against verified risks.449 Dentists are a valuable
source of accurate information regarding water fluoridation for their patients and their communities.
