RFK Jr., Water Fluoridation, and the Future of Public Health: A Nation Divided on Dental Care

Robert F. Kennedy Jr., a person known for his skepticism of many innovative modern health policies, has taken on a position that could reshape the nation’s approach to public health. RFK Jr. was recently nominated by President-Elect Donald Trump to lead the Department of Health and Human Services(DHHS), the United States' top health agency.

To display his credentials as Secretary of the Department of Health and Human Services, RFK Jr. ditched the shirt at Gold’s Gym in Venice, California

The United States has consistently ranked last among major industrialized countries in terms of healthcare outcomes (which includes dental care). Infamous for subpar healthcare equity and outcomes that don’t match the record-high price tag per-capita that Americans pay, the U.S. healthcare system is a failing one. Maybe, come 2025, Kennedy will help save America’s dwindling healthcare system and hold his slogan to ‘Make America Healthy Again’ to heart.

U.S. Healthcare in the bottom right exhibits extremes in both high healthcare spending and low health system performance

Kennedy was a surprising choice to lead the DHHS to say the least. Healthcare leaders have pointed out Kennedy’s lack of qualifications to lead such a crucial agency. The DHHS oversees Medicare and Medicaid programs, the FDA, CDC, NIH, and is a key source of scientific research funding. The incredible importance of the DHHS is why there is a concern of Trump vowing to let Kennedy “go wild on health” with a department with a 1.7 trillion dollar budget that affects the lives of all 340 million Americans. The topic of today is one of Kennedy’s outspoken health endeavors if he assumes the position: The strive to remove fluoride in all of America’s public water systems.

The Origins of Water Fluoridation:

In the 1940s, scientists discovered that people who lived where drinking water supplies had high naturally occurring fluoride levels had fewer cavities than people who lived where fluoride levels in drinking water were lower. The impact of water fluoridation was a dental and public health milestone, starting in the U.S. in Grand Rapids, Michigan. It has become a widely common practice in the United States with over 70% of the U.S. population receiving fluoridated water.  Ever since water fluoridation’s beginning, a deep controversy has ensued over its benefits and harms,  both scientifically and ethically.

The Benefits of Water Fluoridation…

1. Prevents and even reverses dental cavities, limiting tooth decay for both children and adults

-A key mineral for children, fluoride can reduce the incidence of cavities from 33%–80% 

-Adults who have had access to fluoridated water for more than 14 years saw an 11-12% reduction than adults without fluoridated water

2. A simple, cost-effective measure to improve oral health

-In the U.S. in 2013, the per capita cost of water fluoridation ranged from $0.11 to $4.92 depending on community population size

-Communities in the U.S. with water fluoridation save $32 per person annually by avoiding dental treatment costs

3. Equitable access that benefits everyone in the community

-Benefits everyone who consumes tap water, no matter their age, income, or access to dental care.

The Skepticism Over Water Fluoridation…

 First, watch this minute-long interview with Kennedy speaking out against fluoride. 

1. Too much fluoride over a long period of time can cause fluorosis

   -Only children younger than 8 can get fluorosis

   
   

   -In the U.S., fluorosis is mostly mild, causing minor tooth discoloration

2. Fluoridated water leads to cancer, IQ loss, bone deterioration

   
   

   -The National Cancer Institute finds no correlation between water fluoridation and cancer

-Higher levels of fluoride exposure, such as drinking water containing more than 1.5 mg/mL of fluoride, are associated with lower IQ in children. However, this concentration of fluoride in water is twice the amount that is added to the majority of places in the U.S. at 0.7 mg/L. There have been no studies that showed lower iq marks from people consuming water with a fluoridation concentration at the 0.7 mg/L mark

-Fluoride intake had no statistically significant influences bone density or fracture risk in adolescents at typical fluoride exposure levels

3. No autonomy for people to make choice of having fluoride in their water 

-Is oral health of individual concern or social responsibility?

-Do the benefits from the decrease in cavities outweigh the harm of infringing on people’s autonomy?

So, is water fluoridation really necessary in the United States?

Water fluoridation remains a vital public health measure in the U.S., providing widespread, cost-effective benefits in reducing cavities and improving oral health equity. Despite concerns about autonomy and potential health risks, the evidence shows no significant enough harm from fluoride levels used in most U.S. water systems to completely remove water fluoridation. Notwithstanding, many major industrialized countries, such as Sweden and Denmark, that have universal health and dental care do not fluoridate water. Nevertheless, the oral health gains for communities in the U.S.—particularly for vulnerable populations that don’t have access to quality dental care —make fluoridation a necessary and justifiable practice in safeguarding oral health and overall public health.