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Fluoride has been added to public water systems in the U.S. since 1945 to help prevent tooth decay, a benefit recognized widely by public health experts. Fluoride strengthens tooth enamel and helps reduce harmful bacteria in the mouth. However, some recent concerns have questioned its safety, especially when exposure levels are too high.
Studies show that extremely high levels of fluoride—often found in natural groundwater—can lead to dental fluorosis (a cosmetic tooth discoloration) or, in rare cases, negative effects on brain development. But at levels used in U.S. tap water (under 1.5 parts per million), the evidence for serious harm is weak or inconsistent. Despite this, some critics have pushed for fluoride to be removed from public water systems.
To understand the impact of such a decision, researchers from Harvard used national health data and built a simulation model of 10,000 children. The model estimated the effects of removing fluoride from drinking water on dental health and health care costs. Results showed that taking fluoride out of water would lead to:
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Over 25 million more decayed teeth in children within 5 years
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$9.8 billion in extra dental treatment costs
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A rise in cavities especially among low-income, publicly insured children
Conversely, improving fluoride levels in communities with too little could prevent 22 million cavities and save $9.3 billion over 5 years.
Although debates about fluoride’s risks continue, the study found no strong evidence that current levels cause neurocognitive harm. Based on this model, removing fluoride from water would likely cause serious dental health setbacks—especially for vulnerable children.
Bottom line: Keeping fluoride in drinking water is not just about cleaner teeth—it’s about protecting public health and reducing long-term health care costs.
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