DeFOREST — Last November, the public works staff in the village of DeForest noticed a problem.
The pumps that delivered fluoride to the village’s drinking water supply were showing signs of wear. They asked village officials whether looking into replacing them was necessary, given the growing debate over the risks and benefits of water fluoridation.
“I don’t think they knew at that point the storm that was about to occur from asking that question,” said Village President Jane Cahill Wolfgram.
In the months that followed, the Madison suburb of about 11,000 became the latest Wisconsin community to be swept up in what has become a national controversy over fluoride, which helps stop early tooth decay by putting minerals back in tooth enamel.
The U.S. has been adding fluoride to drinking water since 1945, and top medical and dental groups including the Centers for Disease Control and Prevention, the American Academy of Pediatrics and the American Dental Association say it’s safe and effective. The CDC calls it one of the 10 greatest public health achievements of the 20th century.
But anti-fluoride activists have for decades argued it’s toxic, and they point to recent research that found an association between higher levels of fluoride and neurodevelopmental issues in children as unshakable proof. They also have the support of Robert F. Kennedy Jr., who could become the nation’s health secretary under the Trump administration and has suggested removing fluoridefrom the U.S. water supply.
DeForest officials voted 4-3 Feb. 4 to remove fluoride from their drinking water, joining nearly 80 Wisconsin municipalities that have moved to discontinue it, according to data from the state Department of Natural Resources. Like elsewhere, the discussion exposed rifts between public health and personal choice.
A majority of people who spoke at a January public hearing asked the board to keep their water fluoridated, including resident Emily Waide.
“DeForest should not be a place where baseless theories are tested to see what happens,” she said.
Critics pick up steam in long-simmering fluoride debate
When Grand Rapids, Michigan, became the first city in the U.S. to add fluoride to its water, school-aged children began to experience dramatic declines in cavities compared to children in surrounding areas. Around this time, tooth decay was a major public health problem — a stunning 50% of adults ages 65 to 74 in the 1960s had lost all their natural teeth.
As of 2022, more than 70% of the U.S. population served by community water systems had fluoridated water — including about 85% of Wisconsinites who drink from a community water system. Research shows it reduces cavities by about 25%.
Fluoride at higher doses has well-documented consequences. Dental fluorosis, or staining of the tooth enamel, can occur when young children take in too much fluoride. Skeletal fluorosis, which is rare in the U.S. but more common in other parts of the world, causes bone and joint problems.
In 2015, the U.S. Public Health Service lowered its recommended fluoride concentration for community water systems from 1.2 mg/L to 0.7 mg/L to provide “the best balance of protection from dental (cavities) while limiting the risk of dental fluorosis.”
But newer research caused some alarm about other negative effects — particularly an August 2024 report from the nation’s National Toxicology Program that noted a link between fluoride levels of 1.5 mg/L and lowered IQs in children. A federal judge in California cited the report in a ruling last fall that mandated the U.S. Environmental Protection Agency take action over such concerns about fluoride.
Notably, the toxicology report doesn’t establish causation, didn’t include data from the U.S. and was examining fluoride levels more than twice as high as what’s in the current water supply. Medical experts have cast doubt on the report’s credibility and applicability to the U.S. water supply, particularly because its authors wrote that it does not address whether the level of fluoride added to U.S. drinking water is associated with changes in IQ.
Still, the report has become a key factor in many local conversations about fluoride.
If there is “any bit of truth” to it, said Sheila Howe, a DeForest resident who spoke in opposition to fluoride at the January public hearing, “we should stop it, 100 percent.”
Increasing number of Wisconsin communities end fluoride
Seventy-eight Wisconsin communities, including DeForest, have discontinued fluoride treatment in their water, DNR data show — and about 38% of them have done so since 2020. Milwaukee still adds fluoride to its water, as do nearly all public water systems in the county. Some smaller villages nearby, like Sussex, Hartland and Mukwonago, have chosen to take it out.
In some communities, it has been argued that eliminating fluoride is a cost-saving move in response to DNR requirements that fluoride be stored separately from chlorine. Others have noted that handling of fluoride by public works staff can be dangerous without proper protective equipment, or that supplemental sources of fluoride, like in toothpaste or naturally occurring in groundwater, should be enough to protect teeth.
But for many, the decision revolves around the rising tide of personal choice in health matters.
“We should always honor the ‘no,'” DeForest village board trustee Taysheedra Allen said as the board voted on the matter. “If someone says they don’t want something, they should not be forced to have it.”
Patrick Remington, emeritus professor at UW-Madison’s School of Medicine and Public Health who began his career at the CDC, said some who oppose fluoride because of its risks aren’t weighing them against the benefits — something people do every day when they choose to drive a car, have a drink or make other choices.
The benefits of fluoride are clear: less tooth decay, Remington said, while the science doesn’t yet show neurodevelopmental problems for children who ingest fluoride at the level in the U.S. water supply.
He pointed to a 2022 study of cavities in school-aged children in the Canadian city of Calgary, which ended community water fluoridation in 2011. Researchers found the prevalence of cavities was “significantly higher” in these children than in another Canadian city that was still fluoridating its water.
Taking it out can also lead to health disparities between people of different income levels.
“People who are well informed and have excellent access to a dentist can get all the information” on how to supplement fluoride once it’s no longer added to their water, Remington said. “People who aren’t so fortunate will be left without knowing.”
Part of the issue: Not remembering what it was like before fluoridation
Cahill Wolfgram, who voted to keep fluoridating DeForest’s water, said residents have already contacted her asking whether the village would provide an alternative now that it will be taken out.
“As much as I would like to believe the issue is done, because it’s very divisive, I don’t think the issue is done yet,” she said.
That appears true across the country. Bills are advancing in a handful of states to repeal fluoride mandates in larger cities, and with Kennedy on track to clinch the nomination for health secretary, it could continue to be a national talking point. Dr. Tom Reid, president of the Wisconsin Dental Association, previously told the Journal Sentinel that Kennedy’s proposal to cut fluoride “scares us” because of its potential effects on people without access to dentists.
Dominique Brossard, chair of the Department of Life Sciences Communication at UW-Madison who studies public opinion on controversial scientific issues, said the science on fluoride is complex and evolving and “fully assessing pros and cons for specific communities is the right way to go.” She noted that several countries in Europe do not fluoridate their water — though many European countries provide free or heavily discounted dental care to all citizens through national health insurance.
Remington said it would be prudent for the U.S. to conduct a comprehensive risk-benefit analysis about fluoride in drinking water done by a nonpartisan body like the National Academy of Sciences. He also said local education could help people, particularly parents of infants and young children, understand how much fluoride they’re getting from different sources. The CDC keeps a list of which communities fluoridate their water, which can be found at nccd.cdc.gov/DOH_MWF/Default/Default.aspx.
As people continue to consider fluoridation, Remington said it’s important to recognize that the U.S. is now decades removed from the public health problem that prompted it in the first place, and people may not fully remember what it was like.
This is true for other science that has become controversial as well, he said, like vaccines for preventable diseases.
“Unless you really understand how disabling it is to have an entire generation of people without teeth, you’re not acknowledging the harm that fluoridated water addressed,” he said. “If your lived experience doesn’t include these harms, you’ll underestimate them.”
Madeline Heim is a Report for America corps reporter who writes about environmental issues in the Mississippi River watershed and across Wisconsin. Contact her at 920-996-7266 or mheim@gannett.com.
This story was updated to add a video.
Original article online at: https://www.jsonline.com/story/news/2025/02/11/as-fluoride-debate-grows-wisconsin-communities-increasingly-say-no/77995623007/