Republican Governor Spencer Cox said he would sign legislation that bars cities and communities from deciding whether to add the mineral to their water systems.

Fluoride strengthens teeth and reduces cavities by replacing minerals lost during normal wear and tear, according to the U.S. Centers for Disease Control and Prevention. The addition of low levels of fluoride to drinking water has long been considered one of the greatest public health achievements of the last century.

Government researchers have found that community water fluoridation prevents about 25 percent of tooth decay.

“We’ve got tried and true evidence of the safety and efficacy of this public health initiative,” said American Dental Association President Brad Kessler, of Denver. Cavities could start emerging in children within months or years of Utah stopping fluoridation, Kessler said.

The ban comes weeks after federal health secretary Robert F. Kennedy Jr., who has expressed skepticism about water fluoridation, was sworn into office.

“It's not a bill I care that much about,” Cox added, “but it's a bill I will sign.”

Utah lawmakers who pushed for a ban said putting fluoride in water was too expensive. Its Republican sponsor, Representative Stephanie Gricius, acknowledged fluoride has benefits, but said it was an issue of “individual choice” to not have it in the water.

Cox said that like many people in Utah, he grew up and raised his own children in a community that does not have fluoridated water — or what he called a “natural experiment.”

“You would think you would see drastically different outcomes with half the state not getting it. We haven’t seen that,” Cox said in a weekend interview. “So, it’s got to be a really high bar for me if we’re going to require people to be medicated by their government.”

Already, some cities across the country have gotten rid of fluoride from their water, and other municipalities are considering doing the same. A few months ago, a federal judge ordered the U.S. Environmental Protection Agency to regulate fluoride in drinking water because high levels could pose a risk to kids’ intellectual development.

A Utah teenager who urged lawmakers to pass the bill described suffering a medical emergency when the fluoride pump in Sandy, Utah, malfunctioned in 2019, releasing an excessive amount of the mineral into the drinking water. The fluoride sickened hundreds of residents and led many in Utah to push for its removal.

It’s rare to find high levels of fluoridation in water, according to the National Institutes of Health. The agency said it’s “virtually impossible” to get a toxic dose of fluoride from water with standard levels of the mineral.

Kessler said the amounts of fluoride added to drinking water have been reduced over time and are below levels considered problematic.

“The science proves that it is effective at reducing cavities with little to no risk of other problems,” he said.

He added that a ban in Utah could have a domino effect with other legislatures being encouraged to follow suit with fluoride bans in their states.

Opponents warned it would disproportionately affect low-income residents who may rely on public drinking water having fluoride as their only source of preventative dental care. Low-income families may not be able to afford regular dentist visits, or the fluoride tablets some people buy as a supplement in cities without fluoridation.

Fluoridation is the most cost-effective way to prevent tooth decay on a large scale, said Lorna Koci, who chairs the Utah Oral Health Coalition.

Utah in 2022 ranked 44th in the nation for the percentage of residents that receive fluoridated water, according to data from the Centers for Disease Control and Prevention. About two in five Utah residents served by community water systems received fluoridated water.

In February, the city council in Riverton, a Salt Lake City suburb, unanimously passed a resolution to remove fluoride from the city’s public water systems. Voters in Brigham City, 59 miles (95 kilometers) north of the capital city, struck down by a large margin a measure in 2023 that would have removed the mineral from its public water supply.

Out of the 484 Utah water systems that reported data to the CDC in 2024, only 66 fluoridated their water, an Associated Press analysis showed. The largest was the state’s biggest city, Salt Lake City.

Rodney Thornell, president of the Utah Dental Association, began practicing dentistry in a Salt Lake City suburb before the city added fluoride to its water. His adult patients who grew up locally continue to get lots of cavities but younger patients who grew up with fluoride in the water get fewer, he said.

“If we’re going to keep eating sugar, we need fluoride.” Thornell said, noting that Utah residents consume more than the national average of candy and sugary drinks.

Discussion Questions

1. What are the arguments for the fluoridation of water? What are the arguments against the fluoridation of water?

In terms of the arguments for the fluoridation of water, as indicated in the article:

“Fluoride strengthens teeth and reduces cavities by replacing minerals lost during normal wear and tear, according to the U.S. Centers for Disease Control and Prevention. The addition of low levels of fluoride to drinking water has long been considered one of the greatest public health achievements of the last century. Government researchers have found that community water fluoridation prevents about 25 percent of tooth decay. ‘We’ve got tried and true evidence of the safety and efficacy of this public health initiative,’ said American Dental Association President Brad Kessler, of Denver. Cavities could start emerging in children within months or years of Utah stopping fluoridation, Kessler said.”

Additionally, from the article:

“Opponents (of the fluoridation ban) warned it would disproportionately affect low-income residents who may rely on public drinking water having fluoride as their only source of preventative dental care. Low-income families may not be able to afford regular dentist visits, or the fluoride tablets some people buy as a supplement in cities without fluoridation. Fluoridation is the most cost-effective way to prevent tooth decay on a large scale, said Lorna Koci, who chairs the Utah Oral Health Coalition.”

In terms of the arguments against the fluoridation of water, the article indicates that Utah lawmakers who pushed for a ban said putting fluoride in water was “too expensive” (No detail regarding expense is included in the article.)

There is also anecdotal evidence in the article regarding a Utah teenager who urged lawmakers to pass the bill after suffering a medical emergency when the fluoride pump in Sandy, Utah, malfunctioned in 2019, releasing an excessive amount of the mineral into the drinking water. The fluoride sickened hundreds of residents and led many in Utah to push for its removal.

Although this anecdotal evidence is certainly unfortunate in terms of the health problems described, the example refers to an error made in the distribution of flouride, not to any problems associated with fluoridation itself. By analogy, who would favor ending all surgeries due to one surgeon committing malpractice during a surgical procedure?

2. As the article indicates, Utah Governor Spencer Cox said he would sign legislation that prevents cities and communities from deciding whether to add flouride to their water systems. He further stated that “It's not a bill I care that much about, but it’s a bill I will sign.” In your opinion, what did Governor Cox mean by that statement? Should he sign into law legislation that he does not “care that much about?”

This is an opinion question, so student responses may vary. In your author’s opinion, it certainly sounds like Governor Cox is attempting to distance himself from the political fallout that may occur when residents realize that the benefits of water fluoridation outweigh the costs.

Student opinions may differ in terms of whether the governor should sign into law legislation that he does not “care that much about.”

3. As the article indicates, Utah will become the first state to ban fluoride in public drinking water, despite widespread opposition from dentists and national health organizations. In your opinion, in determining whether health-related legislation should be enacted, how much weight should be given to medical professionals? Explain your response.

In your author’s opinion, the opinions of medical experts should outweigh any countervailing opinions, unless the citizenry is, from a public policy standpoint, not worth the cost of water fluoridation.

Obviously, medical experts are in the best position (including the position of legislators) in deciding whether fluoridation of water is a significant public health concern.