106 l © 2025 American Dental Association
Section 4: Public Policy
had the benefit of fluoride in the water their entire lives. And, in some cases, because fluoridation
campaigns often become political campaigns, there are political factors that can sway a vote that
have nothing at all to do with fluoridation. Clever use of emotionally charged “scare” propaganda by
fluoride opponents creates fear, confusion, and doubt within a community when voters consider the
use of fluoridation.461,462 Defeats of referenda to initiate fluoridation or victories in discontinuance of
fluoridation efforts have occurred most often when a small, vocal, and well-organized group has used
a barrage of fear-inspiring allegations designed to confuse the electorate.
In addition to attempts to influence voters, opponents have threatened community leaders with
personal litigation.456 While no court of last resort has ever ruled against fluoridation, community
leaders can be swayed by the threat of litigation due to the cost, time, and emotional energy involved
in defending even a groundless suit, not to mention threats of political fallout. The ADA knows of
no cases in which community leaders have been found liable for their pro-fluoridation efforts. In no
instance has fluoridation been discontinued because it was proven harmful in any way.456,462,463
Defeats of referenda to initiate fluoridation or victories in discontinuance of
fluoridation efforts have occurred most often when a small, vocal, and well-
organized group has used a barrage of fear-inspiring allegations designed to
confuse the electorate.
The adoption of fluoridation is ultimately a choice of state or local decision-makers, whether
determined by elected officials, health officers, or the voting public. Fluoridation can be enacted
through state legislation, administrative regulation, ordinance, or public referendum. Fluoridation is
not legislated at the federal level, but at the state and local levels. As with any public health measure,
a community has the right and obligation to protect the health and welfare of its citizens, even if
it means overriding individual objections to implement fluoridation. Those opposed to fluoridation
sometimes comment that “the government is forcing fluoridation” on the community. But who is “the
government?” The fact is, because fluoridation is implemented by votes of elected state legislatures,
city councils, county commissions, or directly by the public, the people are “the government.”
Experts continue to stress the importance of maintaining fluoridation. As Anne-Marie Glenny, a
professor of health science at the University of Manchester and a Cochrane review author,27 states,
“I’m not aware of anything that would support stopping fluoridation where it’s already in place. Without
considering programs to replace the fluoride people currently get from water, it would be foolish to
take fluoride out.”464 These comments underscore the importance of fluoridation as a public health
measure to prevent tooth decay, even amid growing political and social challenges.
Section 4: Public Policy
had the benefit of fluoride in the water their entire lives. And, in some cases, because fluoridation
campaigns often become political campaigns, there are political factors that can sway a vote that
have nothing at all to do with fluoridation. Clever use of emotionally charged “scare” propaganda by
fluoride opponents creates fear, confusion, and doubt within a community when voters consider the
use of fluoridation.461,462 Defeats of referenda to initiate fluoridation or victories in discontinuance of
fluoridation efforts have occurred most often when a small, vocal, and well-organized group has used
a barrage of fear-inspiring allegations designed to confuse the electorate.
In addition to attempts to influence voters, opponents have threatened community leaders with
personal litigation.456 While no court of last resort has ever ruled against fluoridation, community
leaders can be swayed by the threat of litigation due to the cost, time, and emotional energy involved
in defending even a groundless suit, not to mention threats of political fallout. The ADA knows of
no cases in which community leaders have been found liable for their pro-fluoridation efforts. In no
instance has fluoridation been discontinued because it was proven harmful in any way.456,462,463
Defeats of referenda to initiate fluoridation or victories in discontinuance of
fluoridation efforts have occurred most often when a small, vocal, and well-
organized group has used a barrage of fear-inspiring allegations designed to
confuse the electorate.
The adoption of fluoridation is ultimately a choice of state or local decision-makers, whether
determined by elected officials, health officers, or the voting public. Fluoridation can be enacted
through state legislation, administrative regulation, ordinance, or public referendum. Fluoridation is
not legislated at the federal level, but at the state and local levels. As with any public health measure,
a community has the right and obligation to protect the health and welfare of its citizens, even if
it means overriding individual objections to implement fluoridation. Those opposed to fluoridation
sometimes comment that “the government is forcing fluoridation” on the community. But who is “the
government?” The fact is, because fluoridation is implemented by votes of elected state legislatures,
city councils, county commissions, or directly by the public, the people are “the government.”
Experts continue to stress the importance of maintaining fluoridation. As Anne-Marie Glenny, a
professor of health science at the University of Manchester and a Cochrane review author,27 states,
“I’m not aware of anything that would support stopping fluoridation where it’s already in place. Without
considering programs to replace the fluoride people currently get from water, it would be foolish to
take fluoride out.”464 These comments underscore the importance of fluoridation as a public health
measure to prevent tooth decay, even amid growing political and social challenges.
