This transcript has been edited for clarity.
Hi. I’m Art Caplan. I’m at the NYU Grossman School of Medicine, where I run the Division of Medical Ethics.
It’s hard for me to believe, but fluoride, which as we know is present in the water supply of many parts of the world, has become an issue again. Robert F. Kennedy, Jr, who is a candidate for head of Health and Human Services, put the issue back in the news because he’s been a longtime opponent of adding fluoride to the water in the United States.
I thought this was a settled question, and the fact that it’s come up again as a subject of national debate is very troubling. The evidence, and this can be shared with both patients and the public, that fluoride helps prevent dental cavities and worse oral health problems in children has been stacking up for decades.
It is very clear that prevention by putting fluoride into the water supply works. It’s also pretty clear that the only real danger from doing this is that you get some teeth discoloration if the dose is high.
In fact, the reason people realized that there was fluoride in the water to begin with is that it’s naturally present in some water supplies. People noticed in some towns many decades ago that discoloration of teeth was occurring because the fluoride levels were high. There were occasionally efforts made to lower them to get them down to safe levels to avoid that cosmetic side effect.
What I don’t think is really understood is that the battle over fluoride actually never went away. There are plenty of communities in Florida and Oregon that I’m familiar with, where every year, people who worry about the safety of fluoride or don’t like having it “forced upon them” in the water supply try to get it taken out. There are cities like Tampa where they came very close years ago to winning and getting the water supply changed.
I don’t think there’s any risk here. I think those efforts reflect a weird fear about just the government meddling in something as basic as water. The elevation of the issue now to a national dialogue again is just because it’s been fueled by a prominent person. It’s been in the background for a while.
What I don’t think people understand is there is a basis for some interesting controversy about fluoride. Data show, according to my dentist friends, that if you put fluoride directly on your teeth, if a dentist sprays it on or applies it during a dental visit, that’s more efficacious than putting it in the water supply and drinking it.
You get better rates of cavity prevention if it’s applied directly to the tooth. Whether that shifts the dose or the amount you’re exposed to, I don’t know. I do know that there are more and more dentists saying that it might be most effective if you have it in your toothpaste or as an application when you go to the dentist.
What are the ethics of that? Well, many people don’t go to the dentist, and poor kids certainly aren’t going to the dentist. When I had fluoride applied to my teeth on a previous dental visit, it cost me about $80. That’s $80 that many people aren’t going to spend, much less when they’re not sure they can afford to go to the dentist.
Plenty of Americans don’t. I don’t know the percentage. They might be afraid of the dentist, or they can’t afford to go to the dentist. There are many reasons why, but if you shifted our policy to say, if you want fluoride, have the dentist put it on your teeth. I worry that you’re condemning many poor kids and poor people to a large number of cavities that could have been prevented.
They might not be prevented as efficaciously as if they could have had it applied in the dentist’s office, but it’s the best we’re going to do in a country that has dentistry, oral health, and visiting the dentist much more of an option for the rich than for the poor.
I’m Art Caplan, at the Division of Medical Ethics at NYU Grossman School of Medicine. Thanks for watching.
COMMENTARY
Fluoride in Water Supply Not a Public Health Risk, Says Ethicist
February 20, 2025
This transcript has been edited for clarity.
Hi. I’m Art Caplan. I’m at the NYU Grossman School of Medicine, where I run the Division of Medical Ethics.
It’s hard for me to believe, but fluoride, which as we know is present in the water supply of many parts of the world, has become an issue again. Robert F. Kennedy, Jr, who is a candidate for head of Health and Human Services, put the issue back in the news because he’s been a longtime opponent of adding fluoride to the water in the United States.
I thought this was a settled question, and the fact that it’s come up again as a subject of national debate is very troubling. The evidence, and this can be shared with both patients and the public, that fluoride helps prevent dental cavities and worse oral health problems in children has been stacking up for decades.
It is very clear that prevention by putting fluoride into the water supply works. It’s also pretty clear that the only real danger from doing this is that you get some teeth discoloration if the dose is high.
In fact, the reason people realized that there was fluoride in the water to begin with is that it’s naturally present in some water supplies. People noticed in some towns many decades ago that discoloration of teeth was occurring because the fluoride levels were high. There were occasionally efforts made to lower them to get them down to safe levels to avoid that cosmetic side effect.
What I don’t think is really understood is that the battle over fluoride actually never went away. There are plenty of communities in Florida and Oregon that I’m familiar with, where every year, people who worry about the safety of fluoride or don’t like having it “forced upon them” in the water supply try to get it taken out. There are cities like Tampa where they came very close years ago to winning and getting the water supply changed.
I don’t think there’s any risk here. I think those efforts reflect a weird fear about just the government meddling in something as basic as water. The elevation of the issue now to a national dialogue again is just because it’s been fueled by a prominent person. It’s been in the background for a while.
What I don’t think people understand is there is a basis for some interesting controversy about fluoride. Data show, according to my dentist friends, that if you put fluoride directly on your teeth, if a dentist sprays it on or applies it during a dental visit, that’s more efficacious than putting it in the water supply and drinking it.
You get better rates of cavity prevention if it’s applied directly to the tooth. Whether that shifts the dose or the amount you’re exposed to, I don’t know. I do know that there are more and more dentists saying that it might be most effective if you have it in your toothpaste or as an application when you go to the dentist.
What are the ethics of that? Well, many people don’t go to the dentist, and poor kids certainly aren’t going to the dentist. When I had fluoride applied to my teeth on a previous dental visit, it cost me about $80. That’s $80 that many people aren’t going to spend, much less when they’re not sure they can afford to go to the dentist.
Plenty of Americans don’t. I don’t know the percentage. They might be afraid of the dentist, or they can’t afford to go to the dentist. There are many reasons why, but if you shifted our policy to say, if you want fluoride, have the dentist put it on your teeth. I worry that you’re condemning many poor kids and poor people to a large number of cavities that could have been prevented.
They might not be prevented as efficaciously as if they could have had it applied in the dentist’s office, but it’s the best we’re going to do in a country that has dentistry, oral health, and visiting the dentist much more of an option for the rich than for the poor.
I’m Art Caplan, at the Division of Medical Ethics at NYU Grossman School of Medicine. Thanks for watching.
Any views expressed above are the author's own and do not necessarily reflect the views of WebMD or Medscape.
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