Why Long Island Said No to Fluoride: The Science Behind the Decision

In a bold move that has reignited a heated national debate, Robert F. Kennedy Jr. claims that the incoming Trump administration is considering the removal of fluoride from our drinking water based on health concerns. This assertion taps into a controversy that’s stirred passionate arguments for decades, particularly here on Long Island and across the nation.

While no water supplier on Long Island has added cavity-fighting fluoride for nearly 30 years, a striking 72% of Americans served by public water systems are still enjoying fluoridated water, including residents of New York City.

Kennedy made waves with his statements on social media and during a recent interview, preceding his nomination by President-elect Trump for the role of Health and Human Services Secretary. While Trump has yet to firmly commit to this fluoride removal proposal, the assertion itself has sparked significant interest.

Prominent medical and dental organizations, alongside the Centers for Disease Control and Prevention (CDC), advocate for water fluoridation, pointing to a wealth of studies demonstrating its effectiveness in strengthening tooth enamel and thwarting tooth decay, which remains the most prevalent chronic disease among children in the U.S.

Opposition to fluoridation has existed for years, fueled in part by conspiracy theories and misinterpretations of scientific data. Recent studies have explored potential associations between fluoride exposure and lower IQs or behavioral challenges in children whose mothers consumed fluoridated water, though other research has found no such connections.

While excessive fluoride can lead to health issues, including bone weakening, the levels added to drinking water remain minimal. In 2015, the federal recommendation for fluoride levels in water was lowered due to concerns about dental fluorosis, which causes white staining on children’s teeth. The current guideline stands at 0.7 milligrams per liter, roughly equivalent to three drops of water in a 55-gallon barrel. Naturally occurring fluoride levels in water can vary, and the World Health Organization suggests that fluoride in drinking water should not exceed 1.5 mg.

A recent evaluation by the National Toxicology Program expressed “moderate confidence” that fluoride levels over 1.5 mg per liter may correlate with lower IQs in children, yet insufficient data exists to establish if the current level of 0.7 mg has any adverse effects.

The Fluoride Journey Since the ’40s

Water fluoridation in America kicked off in the 1940s, gaining traction as studies showcased a significant drop in cavities among children in communities with fluoridated water.

In the 1950s, fringe groups like the John Birch Society claimed that fluoridation was a communist conspiracy designed to pacify the American populace. This bizarre notion even made its way into popular culture, famously satirized in Stanley Kubrick’s 1964 film “Dr. Strangelove,” where a character refers to fluoride as “the international communist conspiracy to sap and impurify all of our precious bodily fluids.”

The legacy of such conspiracy theories has led many to shy away from a genuine discussion about fluoride, according to Carol Kopf from Levittown, who has been an active opponent of fluoridation since successfully leading a movement to stop it in her community back in 1983. “People immediately jump to conspiracy theories,” she notes, “but I never called it that.”

Interestingly, opposition to fluoridation transcends political boundaries. Portland, Oregon—one of the most liberal cities in the country—has repeatedly rejected fluoridation, most recently in 2013. Meanwhile, Kentucky boasts the highest fluoridation rate at 99.9%, while Democratic New Jersey lags behind with just 16.1%. New York’s fluoridation rate stands at an average of 71.5%.

Debate continues over just how effective fluoridated water is at reducing tooth decay. A 2017 review of studies from Australia reported reductions as high as 44%, while the CDC and other studies suggest a more moderate impact of about 25%. Some research even posits a mere 15% reduction, or an average of “one-quarter of a tooth.” A Canadian study revealed that Calgary, after discontinuing fluoridation in 2011, saw an 18% increase in cavities among children by age 7 compared to kids in Edmonton, where water remains fluoridated.

For Long Islanders and others lacking fluoridated water, most toothpaste contains fluoride, but Dr. Eugene Porcelli, executive director of the Nassau County Dental Society, argues that fluoridated water offers unique benefits, particularly for strengthening children’s developing teeth.

Previously practicing in Garden City, Dr. Porcelli provided fluoride treatments and supplements to children in Nassau County, recognizing the absence of fluoride in their drinking water.

Some Nassau communities bordering Queens were the last to receive fluoridated water in 1996, following a change in the water supplier’s ownership. In 2022, New York’s Department of Health studied the feasibility of supplying New York City’s water to Nassau due to concerns about saltwater intrusion and the depletion of the aquifer that serves Long Island. The report indicated that removing fluoride from water would be a costly and complex process.

The Hicksville Water District, under the leadership of Superintendent Paul Granger, has never fluoridated its water. Remarkably, he noted that in his 20 years of experience running water authorities, he’s never received a request to add fluoride—though some residents have expressed relief that their water remains unfluoridated.

Kopf argues that when people are educated on the pros and cons of fluoridation, they lean away from it. Granger adds that in a community with widespread dental care access, not adding fluoride allows parents to choose fluoride treatments for their children.

However, Dr. Cynthia Wong, chair of pediatric dentistry at the Eastman Institute for Oral Health at the University of Rochester, points out that many low-income families struggle to access regular dental care, toothpaste, and toothbrushes. Medicaid does cover pediatric dental care, but many dentists refuse to accept it due to low reimbursements. Currently, the institute has 8,500 children on its waitlist, with new patient exams taking up to two years.

Wong frequently encounters children who drink non-fluoridated water suffering from severe tooth decay, impacting their ability to concentrate in school and affecting their diet, often leading to hospitalization. “There really is nothing else as powerful as fluoride against cavities,” she insists.

Assessing the Risks

Nevertheless, some studies have raised alarms regarding fluoridation. Research from Mexico and Canada has suggested a link between fluoride consumption by pregnant women and lower IQs in their children. Conversely, other studies have found no such connections. A 2022 study from Spain not only failed to identify any adverse link but even suggested a correlation between fluoride and higher IQs among boys.

A recent examination of 229 Los Angeles women released in May indicated that higher fluoride levels in pregnant women were associated with increased incidences of neurobehavioral issues, such as anxiety and autism spectrum disorder, in their children by age three. “We advise there should be recommendations in place for limiting fluoride intake during pregnancy,” said lead author Ashley Malin, an epidemiology assistant professor at the University of Florida.

Fluoride is also present in various bottled waters, and Malin advocates for clear labeling of fluoride content—something Canada already implements.

In September, a federal judge in San Francisco referenced Malin’s research while ruling that although the effects of fluoride on child development remain uncertain, there is enough evidence to compel the U.S. Environmental Protection Agency to consider regulations aimed at mitigating risk, albeit without specific directives. The EPA has acknowledged receipt of this ruling and is currently reviewing it.

Dr. Charlotte Lewis, an associate professor of pediatrics at the University of Washington, remains a staunch supporter of water fluoridation, insisting that current evidence does not show any negative impacts on children’s IQ or behavior. She critiques studies like Malin’s for relying too heavily on a single measure of urinary fluoride, which has not been validated as an accurate gauge of chronic exposure.

While Malin contends that further research is necessary, she suggests a cautious approach—potentially halting or significantly reducing fluoride levels in water. In contrast, Jaymie Meliker, a public health professor at Stony Brook University who has extensively researched drinking water’s health impacts, argues that a balanced view leans towards fluoridated water yielding more benefits than risks. “If definitive studies reveal developmental risks for children, a compelling case could be made to eliminate or substantially lower fluoride levels. However,” he cautions, “the current data remains insufficient, and we might see an uptick in tooth decay if changes are made hastily.”

In summary, Meliker points out that if there were indeed a strong negative correlation, we would expect communities without fluoridated water to exhibit significant discrepancies in IQ or neurological outcomes. “So far, I haven’t observed that,” he states, as he prepares to launch a study with Malin examining the effects of fluoride on older adults’ bone health.