Missouri cities are removing fluoride from water. That’s a huge health hazard | Opinion

Community water fluoridation has been a cornerstone of public health for decades because it protects people across their lifespan — especially children and older adults who may not have regular dental visits or even access to basic oral hygiene products.

In Missouri, as in other states, communities have recently revisited this issue. Branson and Houston have already removed fluoride in their water. This year alone:

• In May, Rolla voted to continue fluoridating its water.
• In June, Hannibal voted to end fluoridation at the close of 2025.
• Also in June, Crane voted to stop fluoridating.
• In July, Cabool entered the state-required 90-day notification process, and will vote in October.

Nationwide, 26 states have introduced legislation to change, ban or protect community water fluoridation:

• Fifteen states saw proposed fluoridation bans fail (Alaska, Hawaii, Texas, Louisiana, Arkansas, Tennessee, Kentucky, South Carolina, New Hampshire, Maine, Nebraska, South Dakota, North Dakota, Minnesota and Montana).
• Two states — Utah and Florida — successfully banned fluoridation.
• Four states — Pennsylvania, Ohio, North Carolina and Massachusetts — now have bans pending.
• Seven states — Hawaii, Missouri, Mississippi, Washington, New York, New Jersey and Connecticut — have introduced legislation to protect fluoridation.

The CareQuest Institute for Oral Health conducted two national focus group studies this year exploring public sentiment about fluoridation. Results showed that 52% of Americans support community water fluoridation, while 19% oppose it, with 6% of opponents favoring a full ban. Importantly, the studies found that education about fluoride is most effective when delivered by local dental and medical professionals, and that the weight of the scientific evidence remains the most persuasive factor.

Missouri has made historic progress in improving oral health. In 2022, the state enacted one of the largest Medicaid dental rate increases in its history, raising reimbursements to 80% of average private insurance fees. As a result, 737 new dental providers joined MO HealthNet, the state’s Medicaid provider, and more than 81,000 additional participants received dental services. Today, 43% of licensed Missouri dentists see Medicaid patients — a remarkable gain, though continued progress is needed.

Fluoridation reduces the financial burden on Medicaid, state and federal programs, and taxpayers. Without it, cavities increase and treatment costs rise. Nationally, eliminating fluoridation would add an estimated $45 billion in new dental treatment costs over five years — costs ultimately borne by taxpayers. This is especially concerning because tooth decay remains one of the most common chronic conditions of childhood, disproportionately affecting lower-income families. Only about half of children on Medicaid receive dental care each year.

By preventing tooth decay, fluoridation saves money for families and the health care system. Communities with fluoridated water save an average of $32 per person each year in dental treatment costs — savings that cannot replace the natural strength of enamel protected by fluoride. Beyond the dollars, fluoridation saves time: The Centers for Disease Control and Prevention reports that 34 million school hours are lost annually because of dental problems. However, U.S. Health Secretary Robert F. Kennedy Jr. is a prominent critic of community water fluoridation, despite the clear science supporting its benefits.

I practice in rural Missouri, where many low-income and underserved communities are already dental deserts, with few dental professionals and persistent staffing shortages. Increasing the number of communities without fluoridation would have serious consequences. Dental practices cannot absorb a surge in preventable decay. Simply put, increasing demand without increasing capacity would mean longer wait times, more untreated disease and worsening oral health disparities. Removing community water fluoridation would undermine Missouri’s recent progress, drive up disease rates, overwhelm providers and diminish the return on our Medicaid investment.

The health consequences are real. Untreated cavities can impair nutrition, delay speech and cause infections that can spread to the throat, spine, eyes or brain. Dental decay affects people across all political, social and cultural lines. We have an opportunity to reduce the physical and emotional pain caused by preventable disease through one of the most cost-effective tools available: community water fluoridation.

This is a policy choice with generational consequences. If we are serious about protecting children’s health, we must continue to support community water fluoridation. Standing with science means standing for safer, healthier futures for Missouri’s children.

Dr. Lisa Bosch is a general dentist who owns a practice in Edina, Missouri. She is a trustee to the Missouri Dental Association Board and serves on its Rural Ad Hoc Committee to address dental workforce issues.