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If Donald Trump is elected for a second time, his presidency could threaten what is considered one of the the greatest public health triumphs of the 20th century: adding fluoride, a mineral that helps prevent tooth decay, to drinking water.

This is due to Robert F. Kennedy Jr.THE notorious vaccine skeptic who Trump said will play an important health care role in his administration if elected. “On January 20, the Trump White House will advise all U.S. water systems to eliminate fluoride from public water,” Kennedy said recently. written the. (Trump, in an interview with NBC Newssaid Kennedy’s proposal “seems OK.” “)

Adding fluoride to drinking water reduces tooth decay rates by about 25 percent, according to the U.S. Centers for Disease Control and Prevention (CDC). said. Some American communities have started to do this the 40sand today, approximately 72% of the American population who receive water from public utilities drinks fluoridated water, According to the CDC. Decisions about whether to use fluoride are generally made at the state or local level, and at least a dozen states require large municipalities to do so. Stateline Reports.

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People in countries like Australia and Canada also consume fluoride in drinking water. A 2021 study showed that children living in Calgary, a Canadian city that stopped fluoridating its water, developed significantly more cavities than children living near Edmonton, which uses fluoride.

Despite fluoride’s long-standing presence in drinking water in the United States, celebrated at the federal level, Kennedy is not alone in opposing its use. Anti-fluoridation advocates have called for decades for the mineral to be removed from water supplies, and a number of communities, including Portland, Oregon, Juneau, Alaska, and Wichita, Kansas, have decided not to do so. . add fluoride to their water.

Why all the controversy surrounding a naturally occurring mineral that has been shown to improve oral health?

Although fluoride has demonstrated benefits, particularly in reduce the risk of cavities and tooth decaysome studies have also raised questions about its potential link to health problems ranging from cancer to osteoporosis. The CDC maintains that there is no convincing evidence linking fluoride to “any potential adverse health effects or systemic disorders” and to other major health groups, including American Cancer Society and the American Dental Association (ADA), recognize that it is safe. But concerns remain, particularly regarding the links between fluoride and cognition.

In August, the United States National Toxicology Program (NTP) published a report which found with “moderate confidence” that, at concentrations greater than twice the recommended fluoride level in the United States, fluoridated water is associated with slightly lower IQ scores in children. U.S. standards recommend fluoride levels of 0.7 milligrams per liter of water, and the NTP conclusion applies to water fluoridated at 1.5 milligrams per liter and above.

Early versions of the report failed to obtain permission for an independent review by the National Academies of Sciences, Engineering, and Medicine, which found that the NTP authors had not adequately supported their conclusions with data. Some pro-fluoride organizations, including the ADA, argue that the final version still does not provide conclusive evidence and is not expected to lead to policy changes regarding water treatment.

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Tewodros Godebo, assistant professor at Tulane University’s Celia Scott Weatherhead School of Public Health and Tropical Medicine who studies fluoridesays studies of very high levels of fluoride exposure do not necessarily apply to the United States, where water generally contains much less of this mineral.

Still, it’s worth noting that even government scientists disagree about the safety of fluoridated water, says Christine Till, a professor at York University in Canada, whose research has shown a link between fluoride and lower IQ scores in children. “One authoritative group (the CDC) says it is safe for everyone, and another group of U.S. government experts (the NTP) says there are concerns about the harmful effects of consuming fluoride on child development,” says Till. “At the very least, it’s time to recognize the evolution of science.”

A federal judge in California waded into this debate earlier this year, when he ruled that the U.S. Environmental Protection Agency should strengthen fluoride regulations to address potential risks to children’s cognitive development. This decision does not necessarily mean that fluoride must be removed from drinking water in the United States (the EPA may choose to resolve the situation in several ways, including issuing a public notice about the potential risks and benefits of the mineral ), but it highlights growing surveillance of this practice. of water fluoridation, which some anti-fluoride activists say is no longer necessary now that most people can choose to use fluoride in dental products such as toothpaste. (Till says it’s important to analyze total fluoride exposure, not just exposure through drinking water, when analyzing the mineral’s potential risks and benefits.)

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A Cochrane Review Article 2024 found that adding fluoride to drinking water could lead to slightly fewer tooth decay in children, but concluded that the effects of this practice are less dramatic today than they were before the fluoride is widely present in toothpaste. The authors also noted that adding fluoride to drinking water could increase the number of people with fluoride. dental fluorosisa primarily cosmetic condition that can leave spots, stains or white lines on the teeth.

Fluoridated water, however, helps protect people who do not maintain oral hygiene or do not have access to regular dental care, says Godebo – another factor that complicates any discussion about possible adjustment of the level of dental care. fluoride in American water.

Despite Kennedy’s suggestion that eliminating fluoride would be an immediate priority in a potential Trump administration, Godebo says “the science is not there” to change the U.S. recommendations at this point. “It would be a huge decision,” he says. “It will still take years to reach a conclusion.”

Write to Jamie Ducharme at [email protected].