In 1945, Grand Rapids, Michigan, made history - as the first city in the world to add small amounts of fluoride to its public water supply. At the time, studies showed communities with higher levels of natural fluoride in water had better dental health. Water fluoridation is now practiced in about 25 countries around the world, including Spain, Malaysia, and the United States. In the U.S., approximately 63% of the population drinks fluoridated water.
Low levels of fluoride, a naturally occurring mineral, can be found in many sources of drinking water due to natural processes like the weathering of rocks and human activities like manufacturing. However, there's growing debate over whether additional fluoride should be introduced to drinking water. This year, states including Utah and Florida have banned the use of fluoride in public water systems, and federal officials have called for more states to follow suit.
Nicole Deziel is an associate professor of epidemiology (environmental health sciences) and co-director of the Yale Center for Perinatal, Pediatric and Environmental Epidemiology at the Yale School of Public Health. In an interview, she explains the benefits and risks of fluoride, how "forever chemicals" and climate change impact water quality, and how we can monitor the water we drink.
The interview has been edited for length and clarity.
What are the benefits of fluoride? Are there any potential risks?
Nicole Deziel: Fluoride can strengthen our bones and teeth enamel, and the strengthening of the enamel prevents cavities. But too much of it can damage our bones and enamel in a process called fluorosis, and it can potentially have neurological effects as well.
Finding the right amount where the benefits outweigh the risks is key. The U.S. Public Health Service recommends a fluoride concentration of 0.7 mg/L [parts per million] in drinking water. The World Health Organization recommends a limit of 1.5 mg/L, while the U.S. Environmental Protection Agency sets a limit of 4 mg/L. Newer evidence of more subtle neurological effects is prompting reexamination of these target levels and limits.
Why are we seeing some states ban the use of fluoride in public water systems? Why are some people suspicious of it?
Deziel: There's a long history of controversy about fluoride, including urban legends and conspiracy theories. For some people, it may seem counterintuitive to add a chemical that may have some toxic properties to make our water safer. However, we do this with chlorine as well. Chlorine is toxic at high levels and can form harmful byproducts, but we add it to drinking water to disinfect it and kill bacteria and pathogens to make our water safe to drink. We're often doing these kinds of tradeoffs in environmental health and public health. In addition, misinformation and distrust of science could all be contributing to us revisiting this [the fluoridation of water].
