A Troubling ‘What If’?

Posted June 16, 2025 & filed under Children's Oral Health and Fluoride, Facts about Fluoride.

In recent months, two states — Utah and Florida — have adopted laws banning water fluoridation, a practice that the Centers for Disease Control and Prevention has hailed for reducing tooth decay. What if the remaining 48 states followed suit? A new study sought to answer that question.

The study, published by JAMA Health Forum, analyzed data for nearly 8,500 children from the U.S. National Health and Nutrition Examination Survey (2013 – 2016). The authors concluded that if all 50 states banned water fluoridation, children would suffer 25.4 million additional decayed teeth over a five-year period. This translates into one additional cavity in one out of every three children.

If a nationwide ban endured for a 10-year period, the study predicted that children would experience an additional 53.8 million decayed teeth.

Dr. Lisa Simon, an internal medicine physician and co-author of the study, explained the purpose of this analysis to NBC News. “We thought this was a really important time to be able to put some numbers to the discussions” about fluoride in drinking water, Dr. Simon said.

Although these findings are hypothetical, they reflect the experience of children in Calgary after the Canadian city ceased fluoridation in 2011. A study found that the tooth decay rate among second-grade children in Calgary rose significantly beyond the rate for second-grade children in Edmonton, a fluoridated city in the same province.

Treating tooth decay is costly. The JAMA Health Forum study predicted that a nationwide ban would be likely to increase children’s decay to such a level that an additional $9.8 billion would be spent over five years. This aligns with a 2016 study concluding that fluoridation saves money by reducing the need to treat decay.

Previous research also has established that water fluoridation reduces “income-related inequalities in dental [decay].”

The JAMA Health Forum study probably understates the impact of a nationwide ban because adults, who also benefit from fluoridated water, were not considered in this analysis. Studies like this one often focus on children because more oral health data are available for children.