Thirty-seven states in the U.S. give local governments and residents authority over fluoridation decisions. Thirteen states, as well as Puerto Rico and the District of Columbia, have laws intended to mandate statewide fluoridation. Most only require compliance if the state government provides the funding for fluoridation infrastructure and chemicals. Two states, Michigan and Georgia, have mandate laws, but since their introduction they have been amended to give municipalities the ability to opt-out.

The information on states before the year 2000 comes from:

Mandatory State Laws on Fluoridation
Prepared by Tom Reeves, CDC Fluoridation Engineer
December 1, 2000
(Source: Juneau Fluoride Study Commission, Exhibit C, pages 97-101, July 11, 2006)

Mandatory Laws: 

Arkansas (2011)

On March 4, 2011, Gov. Mike Beebe signed Act 197 into law. This law mandates fluoridation for water systems supplying 5,000 people or more, with two exceptions: (1) communities who receive their water from another state do not have to comply; (2) funds to pay capital start – up costs for fluoridation equipment cannot come from taxes.
NOTE: “… an offer by Delta Dental of Arkansas to donate $500,000 toward startup costs for 32 water systems affected by the bill and a survey showing public support for the measure helped make the effort successful…” ADA’s press statement, March 17, 2011.
POPULATION RECEIVING FLUORIDATED WATER:
1992:  58.7%
2000:  59.9%
2006:  64.4%
2012:  66.9%
2014:  70.7%
2016:  85.6%
2018:  85.4%

District of Columbia (1952)

Has only one water system and it has been fluoridated since 1952.
2012 UPDATE: Population receiving optimally fluoridated water: 100%

California (1995)

Fluoridation is mandated for communities of 10,000 or more service connections (estimated 25,000 population).
“Outside” funds must be found for purchase, installation, and operations of the fluoridation system.
The law does not address water supply wholesalers. The law sets a MCL of 2.0 mg/L. California’s law cannot be enforced unless “outside” funds are made available to the community for purchase, installation, and operation of the fluoridation system.
UPDATE:
• Implementtion of mandatory fluoridation began in 2007 affecting approximately 18 million Southern Californians.
• Recommended range of 0.7 to 0.8 part per million
POPULATION RECEIVING FLUORIDATED WATER:
1992:  15.7%
2000:  28.7%
2006:  27.1% (9,881,390 people)
2012:  63.7% (38,041,430 people)
2014:  63.7%
2016:  60.6%
2018: 59.3%

Connecticut (1965)

set lower limits on the size of the communities which must comply. Fluoridation is mandated for communities with populations of 20,000 or more and natural fluoride content of less than 0.8 mg/L. Fluoridation levels must be maintained between 0.8-1.2 mg/L.
• Mandatory Fluoridation – 2013 Update
POPULATION RECEIVING FLUORIDATED WATER:
1992:   85.9%
2000:   88.8%
2006:   88.9%
2012:   90.3%
2014:  89.5%
2016: 89.5%
2018:89.5%

Delaware (1998)

Fluoridation is mandated for all municipalities but not rural water districts. State funds will pay for fluoridation equipment, but not chemicals, for three years from date of passage of the law. Delaware, which had previously passed a mandatory law in 1968, changed it to require a referendum in 1974, then changed it again to a mandatory law in 1998. Delaware provides funds for fluoridation equipment for 3 years from the date of passage of the law.
POPULATION RECEIVING FLUORIDATED WATER:
1992:   67.4%
2000:   80.9%
2006:   73.6%
2012:   86.3%
2014: 87.1%
2016:87.4%
2018: 85.9%

Georgia (1973)

Contain provisions which allow a community to exempt itself from compliance with the State law, if a community decides it does not wish to institute this public health measure. Georgia’s law cannot be enforced unless money is made available to the community by the state. Law mandates adding fluoride to all incorporated communities. The fluoride level must be no greater than 1 ppm.
Exemption to fluoridation is by referendum. The law provides for “non-compliance” unless state makes funds available for the cost of the fluoridation equipment, the installation of such equipment and the materials and chemicals required for six months.
The law provides tax deduction for cost of device to remove fluoride if person deemed allergic and advised by physician or approved by the Department of Human Resources.
• Georgia water worker fired on Nov 20, 2008, for refusing to purchase and add fluoride to water system
POPULATION RECEIVING FLUORIDATED WATER:
1992:   92.1%
2000:   92.9%
2006:   95.8%
2012:   96.3%
2014:  96.3%
2016:96.2%
2018: 95.2%

Illinois (1967)

The law provides for addition of fluoride according to rules of the Department of Public Health. The fluoride levels must not be less than 0.9 or more than 1.2 mg/L. Regulations specify adding fluoride to all water supplies when the fluoride concentration is less than 0.7 mg/L.
POPULATION RECEIVING FLUORIDATED WATER:
1992:  95.2%
2000:  93.4%
2006:  98.9%
2012:  98.5%
2014:  98.5%
2016:  98.5%
2018:98.2%

Kentucky (1966)

Kentucky statutes clearly delegate powers to the State Board of Health to adopt regulations necessary to protect the dental health of the people. Under this law, Kentucky established standards for approval of public water supplies. These administrative regulations have been challenged in the courts and upheld. Administrative regulations states that fluoridation is required for all communities with a population of 1,500 or more.
POPULATION RECEIVING FLUORIDATED WATER:
1992:  100%
2000:  96.1%
2006:  99.8%
2012:  99.9%
2014:  99.9%
2016:  99.9%
2018:  99.8%

Louisiana (2008)

• The state Legislature approved and Gov. Bobby Jindal recently signed into law Act 761, that requires Louisiana public water systems that serve 5,000 or more customers to add fluoride to drinking water.
• Act 761 states that utilities are not required to move ahead with fluoridation unless the state identifies sufficient funds to cover those costs.
• The new law also allows residents to opt out of fluoridation through a petition signed by at least 15 percent of registered voters and a municipal election.
POPULATION RECEIVING FLUORIDATED WATER:
1992:  55.7%
2000:  53.2%
2006:  40.4%
2012:  43.4%
2014:  43.5%
2016: 44.2%
2018: 39.0%

Michigan (1968)

passed a mandatory state law in 1968, with a lower limit population of 1,000 on the size of the community which must comply, but in 1978, changed their law from “shall fluoridate” to “fluoridate.”
POPULATION RECEIVING FLUORIDATED WATER:
1992:  88.5%
2000:  90.7%
2006:  90.9%
2012:  90.2%
2014:  91.7%
2016: 89.7%
2018:89.5%

Minnesota (1967)

Fluoridation is mandated for all communities except where natural fluoride content conforms with established regulations of the Board of Health. Fluoride levels are to be established by Board of Health regulations. Regulations set levels at average concentration of 1.2 mgs. per liter@ and neither less than 0.9 mgs. nor more than 1.5 mgs.

•• Legislation Text: For the purpose of promoting public health through prevention of tooth decay, the person, firm, corporation, or municipality having jurisdiction over a municipal water supply, whether publicly or privately owned or operated, shall control the quantities of fluoride in the water so as to maintain a fluoride content prescribed by the state commissioner of health. In the manner provided by law, the state commissioner of health shall promulgate rules relating to the fluoridation of public water supplies which shall include, but not be limited to the following: (1) The means by which fluoride is controlled; (2) the methods of testing the fluoride content; and (3) the records to be kept relating to fluoridation. The state commissioner of health shall enforce the provisions of this section. In so doing the commissioner shall require the fluoridation of water in all municipal water supplies on or before January 1, 1970. The state commissioner of health shall not require the fluoridation of water in any municipal water supply where such water supply in the state of nature contains sufficient fluorides to conform with the rules of such commissioner.

POPULATION RECEIVING FLUORIDATED WATER:
1992:  93.4%
2000:  98.2%
2006:  98.7%
2012:  98.8%
2014:  98.8%
2016:  98.8%
2018: 98.8%

Mississippi (2009)

Mississippi Administrative Code 15-6-6:100 mandates that all community water systems serving at least two-thousand people implement fluoridation.  No system will be required to comply unless sufficient funds are provided by the MS State Department of Health. Click here for Mississippi’s Regulations & Guidelines for fluoridation.
NOTE: Incredibly, graduate students from another state at the Univeristy of North Carolina’s Gillings School of Global Public Health’s Department of Health Policy and Management helped convince the Mississippi state legislature to mandate fluoridation (source).
POPULATION RECEIVING FLUORIDATED WATER:
1992: 48.4 %
2000:  46.0%
2006: 50.9%
2012: 79.4 %
2014:  60.0%
2016: 61.0%
2018: 60.7%

Nebraska (1973)

As of 2000: Contain provisions which allow a community to exempt itself from compliance with the State law, if a community decides it does not wish to institute this public health measure. The law mandates adding fluoride to all political subdivisions. It provides an exemption by adoption of an ordinance by initiative. Fluoride is not to be added if the drinking water has a concentration of 0.7 mg/L or greater. Fluorides must be maintained in the range of 0.8-1.5 mg/L; optimum range 1.0-1.3 mg/L.
• In April 2008, the Nebraska Legislature passed LB45. This piece of legislation requires all cities with a population greater than 1,000 to add fluoride to their water supply by June 1, 2010. The legislature included an opt out provision into LB 245. Either by vote of city council or public petition, the question of fluoridation can be put to the vote of the people.
• Summary of Nov 4, 2008,Fluoridation Referendums: 80% (49 out of 61) communities voted against fluoridation.
POPULATION RECEIVING FLUORIDATED WATER:
1992:   62.1%
2000:   77.7%
2006:   69.8%
2012:   71.2%
2014:   71.6%
2016: 71.6%
2018:  71.6%

Nevada (1999)

Nevada passed their law to apply only to counties over 400,000 population and only to water systems in that county that serve a population of 100,000 or more. This applies to 4 water systems in Clark County [Las Vegas]. The law also requires an advisory question must be placed on the ballot in that county at the general election of November 7, 2000, to question if fluoridation of the water should cease in any water system in that county. State regulations required waters systems in Clark County to fluoridate by March 1, 2000. Fluoridation passed in November 7, 2000. It requires the fluoride level to be maintained between 0.7 mg/L and 1.2 mg/L. It also exempts any well that is less that 15% of the total average annual water production of the water system. The law also required a referendum to be held in Clark county on November 7, 2000 to determine if fluoridation should be discontinued. Fluoridation was approved on November 7, 2000.  Nevada, which had passed a law in 1967 requiring a public vote before fluoridation, changed their law in 1999 to mandatory fluoridation in all counties with populations greater than 400,000.
POPULATION RECEIVING FLUORIDATED WATER:
1992:   2.1%
2000:   65.9%
2006:   72.0%
2012:   73.5%
2014:  73.7%
2016: 75.0%
2018:  75.0%

Ohio (1969)

Law mandates adding fluoride to systems supplying a population of 5,000 or more when natural content is less than 0.8 mg/L. The system must maintain a fluoride level between 0.8 and 1.2 mg/L. Ohio has provisions which allow a community to exempt itself from compliance with the State law, if a community decides it does not wish to institute this public health measure. Ohio, placed a time limit of 240 days on the period during which a referendum concerning fluoridation could be held. Ohio provides funds for fluoridation equipment and chemicals.
POPULATION RECEIVING FLUORIDATED WATER:
1992:   87.9%
2000:   87.6%
2006:   89.3%
2012:   92.2%
2014:  92.6%
2016:  92.5%
2018:  92.5%

Puerto Rico (1998)

by the passage of legislation in 1952, provided money for adding fluoride to the water of those aqueducts of the Island of Puerto Rico as may be suitable therefore, as a preventive to dental caries. This, in effect, made fluoridation mandatory in Puerto Rico, but it was not enforced and as of 1997, there was no water fluoridation in Puerto Rico. In September 1998, the Governor of Puerto Rico signed into law a mandatory requirement for water fluoridation. It will be implemented in phases and by the year 2000, 75% of the population in Puerto Rico should be drinking fluoridated water.
2008 UPDATE: While FAN is not aware of any fluoridation scheme in Puerto Rico, in 2006, the Association of State andTerritorial Dental Directors selected the communities of Barranquitas, Cayey, and Fajardo-Ceiba for the 2006Community Water Fluoridation Award Recipients.
NOTE: “Water fluoridation was instituted in Puerto Rico during the years 1953 and 1954. However, during the latter part of the 1980’s, water fluoridation was discontinued due to budgetary constrains…”

South Dakota (1969)

Fluoridation is mandated for all communities of 500 or more except where natural fluoride content conforms to State Department of Health regulations.Regulations specify adding fluoride when the natural content is less than 0.9 mg/L and requires the system to maintain the fluoride concentration within a range of 0.9 mg/L to 1.7 mg/L with an average level of 1.2 mg/L. Public vote by special election was allowed, if petition filed within 120 days of passage of the law. Special election to be held within 90-120 days after date of filing petitions. Provides for reimbursement for actual cost of acquiring and installing equipment, excluding chemicals.
POPULATION RECEIVING FLUORIDATED WATER:
1992:   100%
2000:   88.4%
2006:   95.0%
2012:   93.6%
2014:  93.6%
2016: 93.6%
2018:  93.7%

OTHER:

Massachusetts
Law enables a community through a Board of Health order to implement fluoridation. Implementation is subject to a 90-day waiting period during which a petition for referendum may be filed.
POPULATION RECEIVING FLUORIDATED WATER:
1992:   57.0%
2000:   55.8%
2006:   59.1%
2012:   70.4%
2014:  70.4%

Maine (1957)
have laws which require a public vote before fluoridation can be instituted.
POPULATION RECEIVING FLUORIDATED WATER:
1992:  75.4%
2000:  55.8%
2006:  79.6%
2012:  79.4%
2014:  79.1%

New Hampshire (1959)
have laws which require a public vote before fluoridation can be instituted.
POPULATION RECEIVING FLUORIDATED WATER:
1992:  24.0%
2000:  43.0%
2006:  46.6%
2012:  42.0%
2014:  46.6%
2016:46.5%
2018: 46.7%

Utah (1976)
have laws which require a public vote before fluoridation can be instituted.
POPULATION RECEIVING FLUORIDATED WATER:
1992:  2.0%
2000:  3.1%
2006:  54.3%
2012:  51.7%
2014:  51.7%
2016:52.7%
2018:52.2%

Please email any updates to info@fluoridealert.org – thanks.