Robert F. Kennedy Jr.’s vow to remove fluoride from the nation’s drinking water would be a time-consuming and politically fraught task for the incoming Trump administration — but not an impossible one.

Adding the cavity-fighting chemical to water supplies was one of the 20th century’s signature public health achievements, according to the Centers for Disease Control and Prevention, which calls the practice “a practical, cost-effective, and equitable way for communities to improve their residents’ oral health.” Though nearly two-thirds of Americans drink water with fluoride added to it, that’s a decision made by state and local health authorities — not under the direct control of Washington.

But recent studies about the effect of excessive fluoride levels have raised doubts among some environmental groups and health experts, and a handful of communities have opted to stop fluoridating their water. Now, a September federal court ruling and a 2016 bipartisan chemical safety law are offering a potential avenue that President-elect Donald Trump’s regulators could take to ban fluoridation.

It still wouldn’t be easy, legal experts say.

Pursuing the goal through Environmental Protection Agency regulations would take years and likely face legal challenges. It would meet staunch opposition from the American Dental Association, which says fluoridation is crucial for protecting people without access to quality dental care and prevents at least 25 percent of tooth decay across Americans’ lifespans.

But fluoridation is the rare public health issue where Kennedy and Trump might not find themselves at loggerheads with the full force of the public health and environmental communities that vociferously opposed many of the first Trump administration’s moves.

Trump has pledged to let Kennedy — whose anti-vaccine activism has long thrived on public mistrust of government — “go wild” on health issues. And Kennedy doubled down Wednesday on his pledge to rid drinking water of fluoride.

Asked by NPR’s Steve Inskeep whether Trump’s appointees would issue a call for removing fluoride from water on Inauguration Day — something Kennedy had pledged on X over the weekend — the former environmental attorney said: “Yes, that is something the administration will do.”

During his victory speech early Wednesday morning, Trump said he would empower Kennedy broadly to act on his agenda, outside of oil and gas policy. “He wants to go do some things and we’re going to let him go to it,” Trump told supporters in West Palm Beach, Florida.

The federal government does not require water utilities to add fluoride to their supplies, but since the 1960s it has recommened adding small amounts to prevent cavities. The U.S. Public Health Service most recently reviewed those recommendations in 2015, when it lowered the amount it considers optimal.

Scientists broadly agree that excessive exposure to fluoride over long periods can cause health problems such as dental fluorosis, which leaves teeth looking pitted or brown, and skeletal fluorosis, which can affect joints and cause osteoporosis. Because fluoride can naturally occur in water supplies, EPA set a federal drinking water limit for the chemical in 1986, which is nearly six times higher than the recommended level.

But concerns have grown in recent years over the chemicals’ neurotoxic effects. A recent review by the National Institutes of Health’s National Toxicology Program concluded with “moderate confidence” that long-term exposure to fluoride at levels more than twice the federal government’s recommended level are “consistently associated with lower I.Q. in children.” However, the report said more studies are needed to understand the relationship.

That scientific analysis helped lead a federal judge in a long-running lawsuit brought by anti-fluoride groups to conclude that even the federally recommended levels pose “an unreasonable risk of injury to health of the public.”

U.S. District Judge Edward Chen in Northern California — originally nominated by President Barack Obama — was careful to say his ruling was not a final finding that fluoride “is injurious to public health.” But he said the risk was enough to trigger a regulation under the federal Toxic Substances Control Act.

While fluoride in drinking water has not been a priority for major environmental and public health groups, that ruling garnered respect from some high-profile voices in the movements.

Linda Birnbaum, a former director of the National Institute of Environmental Health Sciences and the National Toxicology Program, has called Chen’s ruling “excellent.” Birnbaum had sparred with the first Trump administration over its handling of PFAS “forever chemicals.”

Fluoride’s benefits are topical, she said by email Wednesday. “We should not be exposing all fetuses and infants to something that can impact their brains.”

Kennedy made the same point in the NPR interview.

“Fluoride made sense in the 1940s when they put it in, but now we have fluoride in toothpaste,” he said. “We don’t need fluoride in our water and it’s a very bad way to deliver it because it’s delivered through the blood system.”

Some communities have already stopped fluoridating their water in light of the court ruling.

Now, the ruling gives the Trump administration a path for banning the chemical in drinking water, said Robert Sussman, an environmental litigator and former EPA deputy administrator during the Clinton administration. And it’s a much simpler one than the route provided by the Safe Drinking Water Act, the primary federal law governing chemicals in drinking water, which is designed to set safety limits rather than to impose outright bans, he said.

“EPA does have broad authority under TSCA, and if [the administration wants to be] really aggressive in its approach to implementing a ban, there are certainly the authorities there,” he said.

In fact, EPA has recently used the law to ban asbestos and methylene chloride, a chemical used in paint strippers and linked with at least 88 deaths, according to EPA.

But the EPA office that implements the toxic chemicals program has struggled to keep up with the pace that the law demands. Adding fluoride regulation as a major new priority could affect the agency’s bandwidth on other top-priority toxic chemicals such as formaldehyde and trichloroethylene, a widespread chemical made famous by the 1998 legal drama “A Civil Action.”

The Biden administration could still appeal the court decision requiring EPA to regulate fluoride. An EPA spokesperson said the agency is still reviewing the ruling. But even if it does appeal the ruling, the incoming Trump administration could reverse that decision.

Drinking water safety was also one of the Biden administration’s biggest aims, although it focused on contaminants that have been top priorities for environmental and public health advocates.

Biden’s EPA issued the first regulation for a new drinking water contaminant in more than 30 years. That regulation set strict new limits for “forever chemicals” that were used for decades in everything from Teflon cookware to pizza boxes to military firefighting foam and are linked with a host of health ailments ranging from cancer to reduced vaccine effectiveness.

Some Republicans have opposed the PFAS regulation, citing concerns about costs and pragmatism, and industry groups are challenging it in court.

The Biden administration has also made a priority of removing lead from drinking water systems. It secured $15 billion for the effort in the bipartisan infrastructure law and just last month finished a rule updating a 2020 Trump regulation to mandate that nearly all drinking water utilities rid their systems of lead pipes within a decade.

Original article online at: https://www.politico.com/news/2024/11/07/rfk-jr-fluoride-ban-00188032