Fluoride is under fire nationally, driven in part by concerns from Health Secretary Robert F. Kennedy Jr.
In March, Utah became the first state to ban community water fluoridation, followed by a prohibition in Florida that took effect Tuesday.
Now, legislators have taken up the cause in Pennsylvania.
A pair of bills introduced last month in the Pennsylvania legislature would ban added fluoride from public water systems statewide.
Anya Sostek
With fluoride again drawing criticism, sorting out its prevalence in Pittsburgh-area drinking water
Sen. Dawn Keefer, R-York, introduced the Fluoride Choice Act in the Senate on June 19 amid “growing concerns about the safety and necessity of water fluoridation,” she said in a press release. Rep. Jason Ortitay, R-Canonsburg, introduced the House version of the bill six days later.
The bills have alarmed dental health advocates, who say that removing fluoride from public water systems will lead to more cavities, especially in vulnerable populations.
Fluoride, a naturally occurring mineral, was first added to public drinking water in the U.S. in 1945. Used in the right quantities, it helps prevent tooth decay by hardening the enamel around a tooth, reducing cavities by about 25% in children and adults.
The majority of the country drinks fluoridated water, but Pennsylvania — with 1,800 different water systems — is split, with fluoride added to about 55% of the state’s community water systems. Most, though not all, of Allegheny County drinks fluoridated water, while most of Westmoreland County does not.
The bills in the Pennsylvania legislature would prohibit any public water systems in Pennsylvania from adding fluoride.
Mr. Ortitay said that he started looking into fluoride about 18 months ago, after hearing concerns from a constituent. In his research, he saw that entities like the National Toxicology Program, housed within the Department of Health and Human Services that Mr. Kennedy now oversees, had looked into the link between high levels of fluoride exposure and lower IQ scores in children.
In her release introducing the legislation, Ms. Keefer referenced a 2024 study in JAMA Pediatrics that linked high fluoride exposure to lower IQ scores in children, as well as a federal court ruling in California last year that said high fluoride levels might cause unreasonable risk to children.
“We try to do no harm,” said Mr. Ortitay, “and if we see science and data and information that says, ‘hey, this could be problematic,’ then why don’t we at least take a pause and step back and say, ‘Why don’t we just take this out of the equation while we study it further?’”
Mr. Kennedy tweeted in November that the Trump administration would urge all U.S. water systems to remove fluoride, calling the mineral “an industrial waste associated with arthritis, bone fractures, bone cancer, IQ loss, neurodevelopmental disorders, and thyroid disease.”
The concern, say dental groups, is that taking fluoride out of the water is doing harm, in that it will likely increase tooth decay, particularly in children.
The studies cited by Mr. Ortitay and Ms. Keefer all look at levels of fluoride exposure that are well above those in American public water systems, said Helen Hawkey, executive director of the PA Coalition for Oral Health.
“In 2,000 studies, no study has ever shown harm in the level we use in water — ever,” she said. The studies that showed harm were done internationally, she said, in places such as rural China where children drink water with fluoride that naturally occurs at levels as high as 8 or 10 milligrams per liter.
After Utah passed its fluoride ban, the president of the American Dental Association decried the state’s reasoning as “distorted pseudo-science” and warned other states against following suit.
“The most common chronic childhood disease is cavities,” said Brett Kessler, president of the American Dental Association. “We know that when community water fluoridation stops, it’s the children and the most vulnerable of our communities who suffer. We urge legislators and voters across the country not to make Utah’s significant mistake, and, instead, to trust credible data and science which shows that optimally fluoridating community water is safe, effective and helps prevent dental disease.”
According to the U.S. Public Health Service, the optimal level of fluoride in drinking water is 0.7 milligrams per liter of water, equal to about three drops in a 55-gallon barrel. The Centers for Disease Control and Prevention lowered that limit in 2011 after determining that children were also getting fluoride from other sources besides drinking water, such as toothpaste and mouthwash.
The maximum level of fluoride allowed in Pennsylvania water systems is 2 milligrams per liter.
Fluoridated water is important for dental health because fluoride offers additional protections when taken systemically, rather than applied directly to the teeth through toothpaste or dental treatments, said Ms. Hawkey. Additionally, parents are urged to use fluoridated toothpaste sparingly with young children, and to monitor them closely to make sure they don’t swallow it.
A study published in 2024 in the Journal of the American Dental Association found that children in school districts in Pennsylvania with fluoridated water had 16% fewer cavities than children in school districts without community water fluoridation.
Pennsylvania already has a dental shortage, with long waits for dentists that serve patients on Medicaid and other special populations, said Ms. Hawkey. “We don’t have anyone to treat the cavities that are already there,” she said.
Mr. Ortitay said he believed that removing fluoride from water systems wouldn’t have that much of an impact, given the prevalence of fluoridated toothpaste. And even if it did, he said, he is more concerned with the potential for harm.
“Is it worth the risk that we could be hurting the brains of young kids over cavities?” he asked. “Teeth can be filled, especially in kids. Kids lose teeth, they get new teeth. We’re putting a chemical in water that could be hurting their development. I understand the concern about teeth, but I’d rather have my brain functioning where there are secondary and alternative methods like brushing my teeth and getting that fluoride other than public water.”
He acknowledged, however, that given the current makeup of the Pennsylvania legislature, with Democrats in control of the House of Representatives, his bill was unlikely to become law.
“I’m not naive — I’m in the minority,” he said. “But I would hope that this bill could at least get a hearing. We bring in some experts, we look at the studies, we just evaluate the merits of the bill and if other legislators agree, then maybe we try to push for a vote. If they don’t and they want more information then we just keep researching and keep looking at it.”
Original article online at: https://www.post-gazette.com/news/health/2025/07/05/pennsylvania-fluoride-ban-bill/stories/202507040031