As of Tuesday morning, Florida water providers were no longer adjusting the level of fluoride in their water supplies. While applauded by skeptics of the practice, dental experts are concerned that there could be oral health impacts to Florida's most vulnerable populations, like children and the elderly.
The Legislature passed a bill (SB 700) that was then signed by Gov. Ron DeSantis that prevents water providers from adding quality "additives" to a drinking source. The bill makes no mention of fluoride.
Florida is the second state, behind Utah, to ban fluoridation.
Ninety-seven water providers from 27 counties ended fluoridating Tuesday, according to the Florida Department of Health.
Orange County, which has seven water providers, said, "in response to the passage of state legislation, Orange County Utilities will stop supplementing the naturally present fluoride in water prior to July 1, 2025."
Fluoride is a naturally occurring mineral in most bodies of groundwater. According to the Centers for Disease Control and Prevention, the recommended level of fluoride in drinking water is 0.07 parts per million, which experts describe as three drops of liquid into a 55-gallon aquarium.
Orange County Utilities released a statement prior to the law taking effect stating it would cooperate with the changes but "naturally occurring fluoride, which exists in Florida groundwater at an average concentration of 0.14 (ppm), will remain."
Only one Florida county will continue to provide water services with the 0.07 ppm level of fluoride, Duval, because its fluoride level naturally occurs at the 0.07 ppm, said Johnny Johnson, a retired dentist and the president of the American Fluoridation Society.
"They have a million people who live there. Their water is naturally fluoridated at the optimal amount," he said. The law "is not making them take it out of the water."
Johnson, as a longtime advocate for fluoride, is envious of Duval and its naturally optimized mineral content. He's concerned about children and the elderly being severely affected by the loss of fluoride.
"This is going to impact the elderly, those who are in institutionalized, long-term care facilities; they don't get their teeth brushed on a regular basis, if at all," Johnson said. "They will begin to get cavities on the root surfaces of their teeth and very serious issues."
A history of fluoride in water
Gainesville was the first Florida city to add fluoride to its water, starting in 1949, according to the University of Florida. That was about four years after Grand Rapids, Michigan, began fluoridating its water as part of a large-scale study. Inklings of research prior to the Grand Rapids study showed that fluoride could prevent and even reverse early tooth decay, according to the National Institutes of Health.
Bacteria leftover from sugary foods can produce an acid that eats away at the enamel of teeth. Fluoride combats the early stages of tooth decay by replacing the minerals eaten away by the acid.
Eleven years after the Grand Rapids study began, researchers found a 60% drop in the rate of tooth decay.
More fluoridation projects emerged across the country. Prior to SB 700 taking effect, there were 200 million Americans impacted by fluoridation projects.
The effort to end fluoridation
Last year, skeptics of fluoride were emboldened after U.S. Health Secretary Robert F. Kennedy Jr. announced his intent to recommend removal from public water systems. Not long after that, Florida Surgeon General Dr. Joseph Ladapo issued new guidance, discouraging local governments from fluoridating water, calling it "public health malpractice."
Ladapo referenced a number of concerns, including associations between fluoride exposure and attention- deficit/hyperactivity disorder, as well as diminished impulse control and reduced IQ.
According to a metaanalysis of these studies published by the American Medical Association, more than 70% were deemed low quality and highly biased. None of these studies took place in the United States, and most took place in China. Some studies were deemed to be of high quality.
In Florida, the impacts of stopping fluoridation aren't expected to be felt for two to three years, Johnson said. He says in other areas where fluoridating water stopped, vulnerable populations like young children and the elderly found extreme health difficulties despite other fluoride options being available.
"Everybody keeps using fluoridated toothpaste, but cavity rates skyrocket. Hospitalizations to take kids to hospitals for full mouth treatment under general anesthesia skyrocket," he said
Tooth decay, or a cavity, is an infection that leads to the bloodstream. Abscesses in the mouth can lead to extreme health concerns such as cardiac arrest, heart disease and even stroke.
"The most impacted are going to be those of the lowest-income families because they don't regularly see dentists or have access to dental care, even those who have Medicaid coverage. It's a very low usage of Medicaid coverage here in the state of Florida," Johnson said.
Fluoride serves as a supplement to toothpaste and regular visits to the dentist, but it doesn't replace either one, Johnson said.
"There's nothing that replaces water fluoridation," he said.
Copyright 2025 Central Florida Public Media