Long Island rejected fluoride in its water even before RFK Jr. Here's the science

Robert F. Kennedy Jr.’s assertion that the Trump administration will recommend the removal of fluoride from U.S. drinking water for health reasons is highlighting a controversy that has caused battles for decades on Long Island and around the country.

No Long Island water provider has added cavity-fighting fluoride to water for nearly three decades, but 72% of Americans served by public water supplies receive fluoridated water in their taps, including New York City residents.

Kennedy made his comments on X and in an interview before President-elect Donald Trump named him as his choice for health and human services secretary. Trump has not firmly committed to calling for fluoride's removal.

The nation’s largest medical and dental organizations, as well as the Centers for Disease Control and Prevention, recommend water fluoridation because numerous studies have found that the mineral strengthens tooth enamel and prevents tooth decay, the most common chronic disease in children.

There has long been opposition to it, some based on conspiracy theories and misinterpretations of scientific data. But some studies over the past several years have shown associations between fluoride and lower IQs and behavioral problems in children born to women who drank fluoridated water — although other studies have found no such links.

Scientists have long known that relatively high amounts of fluoride can cause health problems, such as weakening of bones, but the amount added to water has been minimal. The federal government in 2015 reduced the fluoride level it recommended for drinking water because of concerns about fluorosis, a white staining on the teeth that can occur in children. The current recommendation is 0.7 milligrams per liter, equal to about three drops of water in a 55-gallon barrel. Fluoride is naturally present in different amounts in almost all water, so the amount added to reach 0.7 mg varies. The World Health Organization recommends that fluoride in drinking water not exceed 1.5 mg.

An August federal National Toxicology Program evaluation stated that although it has "moderate confidence" of a link between more than 1.5 mg per liter of fluoride in water and lower IQs in children, there isn’t enough data to determine if water with 0.7 mg has a negative effect.

Fluoride spread in the '40s

Water fluoridation in the United States began in the 1940s and expanded as studies showed a dramatic drop in cavities among children in communities with fluoridated water.

Starting in the 1950s, far-right groups like the John Birch Society claimed that adding fluoride was part of a communist plot to make Americans more submissive to a communist takeover, and that fear was featured in the 1964 Stanley Kubrick satiric film "Dr. Strangelove," in which a character called fluoride "the international communist conspiracy to sap and impurify all of our precious bodily fluids."

A legacy of those conspiracy theories is that many people refuse to seriously examine the issue, said Levittown's Carol Kopf, who worries about the health effects of fluoride. She helped successfully lead a 1983 effort to stop fluoridating Levittown’s water and is active in several anti-fluoridation groups.

"They think of conspiracies," said Kopf. "I never said it was a conspiracy."

Despite its association with the political right, fluoridation always has had opponents across the political spectrum. Voters in Portland, Oregon, one of the country’s most liberal cities, repeatedly have rejected fluoridation, most recently in 2013. Conservative Kentucky is the state with the nation’s highest fluoridation rate — 99.9% of those with public water — and Democratic New Jersey has the lowest rate, 16.1%, according to the CDC. New York, at 71.5%, is near the national average.

Studies differ as to how much fluoridated water reduces the rate of tooth decay, with a 2017 Australian review of fluoride studies finding the decrease as high as 44%, some studies and the CDC saying it is about 25%, and others concluding it is either 15% or an average of "one-quarter of a tooth." A Canadian study that compared Calgary and Edmonton after Calgary stopped fluoridating water in 2011 found that by age 7, Calgary’s children were 18% more likely to have cavities than Edmonton kids.

Long Islanders and others without fluoridated water can obtain the mineral through most toothpaste. But Dr. Eugene Porcelli, executive director of the Nassau County Dental Society, said fluoridated water has benefits that fluoride toothpaste does not, including in fortifying children's developing teeth.

Before he became director of the dental society, Porcelli practiced in Garden City, where he prescribed fluoride supplements to Nassau children and gave them fluoride treatments because he knew they were not obtaining the mineral from their drinking water.

Several Nassau communities bordering Queens were the last on the Island to receive fluoridated water, in 1996, after a change in ownership of the water supplier.

The state Department of Health in 2022 studied the feasibility of supplying New York City water to Nassau, amid the intrusion of saltwater into the aquifer system that supplies Long Island's drinking water, contamination, and concerns that decreases in the aquifer’s level are drying out some streams and creeks. Removing fluoride from water is prohibitively expensive and complex, the report found.

The Hicksville Water District, where Paul Granger serves as superintendent, has never added fluoride. Granger said that in 20 years of running water authorities, he never has received a call requesting that fluoride be added to water — but some residents have expressed relief that their water wasn’t fluoridated.

Kopf said that "when people are educated to the pros and cons, they don't want it in the water." 

Granger said in a community where access to dental care is widespread, not adding fluoride to water "gives the parents, the people, the decision if they want to have fluoride treatment."

Yet Dr. Cynthia Wong, chair of pediatric dentistry at the Eastman Institute for Oral Health at the University of Rochester, said many low-income children do not have access to regular dental care, toothpaste and toothbrushes.

Medicaid covers pediatric dental care, but many dentists don’t take Medicaid because of low reimbursement, she said. The institute has 8,500 children on its waitlist — up to two years for a new patient exam, Wong said.

Wong said she regularly sees children who drink non-fluoridated water with severe tooth decay that can affect their ability to concentrate in school and eat certain foods, and can lead to hospitalization.

"There really is nothing else as powerful as fluoride against" cavities, she said.

Studies suggest risks

Yet some studies have pointed to risks to fluoridation, including ones in Mexico and Canada that linked fluoridated water consumed by pregnant women to lower IQs in their children. Other studies have found no association, and a 2022 one in Spain not only found no link, but an association between fluoride and higher IQs in boys.

A study of 229 Los Angeles women released in May found that higher levels of fluoride in pregnant women were associated with a greater probability of neurobehavioral problems, such as anxiety and autism spectrum disorder symptoms, in their children by age 3.

"We advise there should be recommendations in place for limiting fluoride intake during pregnancy," said the lead author of the study, Ashley Malin, an assistant professor of epidemiology at the University of Florida.

Fluoride is in many bottled waters, and Malin supports labeling bottles with fluoride content, as Canada already does.

In September, a federal judge in San Francisco cited a previous Malin study in ruling that although it’s still not certain whether fluoride can affect children’s development, there was enough data to order the U.S. Environmental Protection Agency to develop regulations to reduce risk, although the judge did not specify what. The EPA said in an emailed statement that it "is in the process of reviewing the district court’s decision."

Dr. Charlotte Lewis, an associate professor of pediatrics at the University of Washington medical school in Seattle and a spokeswoman for the American Academy of Pediatrics, which supports adding fluoride to water, believes evidence still indicates no negative effects on children’s IQs or behavior. She said studies like Malin’s relied too much on a single measure of women’s urine, which "has never been validated as a way to measure chronic exposure to fluoride."

Malin said although more research is needed, it’s best to exercise caution and either stop adding fluoride to water or greatly reduce the amount.

But Jaymie Meliker, a professor of public health at Stony Brook University who has extensively studied health effects of drinking water, said research on balance points to more benefits to fluoridated water than risks. If studies conclusively show risks to children’s development, "there would be a very strong argument to remove fluoride, or at least to lower it substantially." But, he said, "there’s just not enough data yet," and he worries about a rise in tooth decay if action is taken now.

"If this was a strong effect, you would expect you’d see that communities that don’t have fluoride in their water would have differential IQ or different neurologic outcomes," said Meliker, who is planning a study with Malin on the effect of fluoride on older U.S. adults’ bones. "I don’t see that yet."

By David Olson

david.olson@newsday.com@DavidOlson11

David Olson covers health care. He has worked at Newsday since 2015 and previously covered immigration, multicultural issues and religion at The Press-Enterprise in Southern California.