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Utah has emerged as the first state in the US to prohibit the addition of fluoride to public drinking water, despite opposition from dentists and national health organizations warning that this decision could cause medical issues that disproportionately affect low-income populations.
On Thursday, Republican Governor Spencer Cox signed a law preventing cities and communities from opting to include the mineral in their water systems.
Meanwhile, other states such as Florida, Ohio, and South Carolina are contemplating similar actions. Conversely, legislators in New Hampshire, North Dakota, and Tennessee have rejected such proposals. In Kentucky, a bill aimed at making fluoridation optional has stalled in the state Senate.
However, communities sometimes exceed the recommended levels because fluoride occurs naturally at higher levels in certain water sources. In 2011, officials reported that 2 in 5 U.S. adolescents had at least mild tooth streaking or spottiness because of too much fluoride.
Since 2015, federal health officials have recommended a fluoridation level of 0.7 milligrams per litre of water. For five decades before that, the recommended upper range was 1.2 milligrams per litre. The World Health Organisation has set a safe limit for fluoride in drinking water of 1.5 milligrams per litre.
Fluoride is considered one of the greatest health achievements in 100 years
The addition of low levels of fluoride to drinking water has long been considered one of the greatest public health achievements of the past century: one of the most cost-effective ways to prevent tooth decay on a large scale.
Fluoride in drinking water can reduce cavities by at least 25 per cent for all age groups, according to the Utah Dental Association. Opponents of the Utah legislation to limit fluoridation warn it will have a disproportionately negative effect on low-income residents who may rely on fluoridated water as their only source of preventative dental care.
It’s a matter of personal choice, Utah’s bill sponsor says
The sponsor of the Utah legislation, Republican Rep. Stephanie Gricius, acknowledged fluoride has benefits, but said it was an issue of “individual choice” to not have it in the water.
Out of the 484 Utah water systems that reported data in 2024, only 66 fluoridated their water, an Associated Press analysis showed. The largest was that in the state’s biggest municipality, Salt Lake City.
Utah in 2022 ranked 44th in the nation for the percentage of residents that receive fluoridated water, according to the CDC data.
