It’s Time to End Water Fluoridation — and Address the Real Cause of Cavities

The debate over fluoride is often framed as a choice between healthy teeth and public safety. That’s a false choice. The real question is whether government should add an industrial chemical to everyone’s drinking water — every infant bottle, every glass of water — without individualized dosing, without informed consent, and without addressing the true root causes of cavities.

Community water fluoridation began in Grand Rapids, Michigan, on January 25, 1945, when sodium fluoride was first added to a municipal water supply.Source: CDC Timeline

It is important to clarify the fluoride now commonly added to public water systems is not the same as naturally occurring calcium fluoride found in some groundwater. Today, the most widely used additive is fluorosilicic acid (H₂SiF₆) — a synthetic compound.

According to the U.S. Environmental Protection Agency, fluorosilicic acid is produced as a byproduct of wet-process phosphoric acid manufacturing, tied to phosphate fertilizer production. It is formed when industrial emissions are captured and scrubbed, creating fluorosilicic acid as a waste stream.Source: EPA Fluorosilicic Acid Supply Chain Profile (2023)

Tennesseans deserve full transparency and the right to choose what they ingest — but there is no meaningful choice when a substance is added to the public water supply. If something is going into everyone’s drinking water, people have the right to know exactly what it is, where it comes from, and to decide for themselves whether they want it at all.

Fluoridation is not done to purify water. It is done to achieve a therapeutic goal — preventing cavities. The FDA’s over-the-counter monograph defines an “anticaries drug” as one that prevents cavities.Source: FDA Final Administrative Order OTC000034 If fluoride is classified as a drug when sold in toothpaste, it raises legitimate ethical questions when delivered through a public utility system.

In fact, the FDA has recently announced action to remove ingestible fluoride drug products for children from the market because they were never formally approved. Source: HHS Press Release That development alone should prompt all to pause. If ingestible fluoride tablets for children require regulatory scrutiny, why should ingestion through drinking water be exempt from similar standards?

Fluoride toothpaste carries a required warning:“Keep out of reach of children under 6 years of age. If more than used for brushing is accidentally swallowed, get medical help or contact a Poison Control Center right away.”Source: FDA OTC Anticaries Drug Monograph

The same ingredient placed in public water carries a poison-control warning when swallowed in larger amounts.

EPA’s substance registry lists sodium fluoride under federal hazardous substance authorities, including 40 CFR 302.4. Source: EPA Substance Registry

The EPA supply chain profile describes fluorosilicic acid as a strong, corrosive acid that can release hydrogen fluoride under certain conditions. These concentrated forms require protective handling in water facilities. Source: EPA Supply Chain Profile (2023)

This is not fear; it is industrial reality.

Modern science indicates fluoride’s primary benefit is topical — acting on erupted teeth.Source: CDC MMWR

Cochrane reviews confirm fluoride toothpaste reduces cavities, while also noting that the benefits of water fluoridation appear smaller in modern populations where toothpaste use is widespread.Source: Cochrane Reviews

Topical fluoride is inexpensive and widely available. If it works primarily topically, forcing ingestion becomes unnecessary.

But here is the deeper issue: no amount of fluoride eliminates cavities. Cavities are not primarily a fluoride deficiency problem. They are driven by high sugar consumption, ultra-processed foods, refined carbohydrates, frequent snacking, disrupted oral microbiomes, and poor overall nutrition. The CDC acknowledges sugar as a major contributor to tooth decay.

We have fluoridated water for decades, yet cavities remain common because modern diets are saturated with added sugars and processed foods. You cannot out-fluoride a high-sugar diet.

If we truly want healthier children, the focus should be on reducing sugar exposure in schools, improving the quality of school meals, and educating families. Addressing nutrition will do more for long-term oral health than medicating water.

There is also a cost and fairness issue. Communities pay ongoing costs to purchase and dose fluoridation chemicals. For families who do not want fluoride, removal is expensive. EPA notes that standard carbon filters do not remove fluoride; effective removal typically requires reverse osmosis or other advanced treatment systems. Source: EPA Fluoride Q&A

So the public pays to add it, and individuals must pay to remove it.

Globally, approximately 95% of the world does not fluoridate its public water systems. Most developed nations rely on topical products and improved nutrition instead of mass water medication.

Meanwhile, scientific discussion continues. The National Toxicology Program reported an association between higher fluoride exposure and lower IQ in children, while noting limitations in how those findings apply to U.S. exposure levels. Source: NTP Review

Other states, including Utah and Florida, have recently taken steps to end water fluoridation. The conversation is happening nationally. Tennessee should examine the evidence and prioritize informed consent and modern health policy. Government’s role is to provide clean, safe water. It is not to medicate the population through the tap.

Fluoride does not eliminate cavities. Sugar and ultra-processed diets drive them. If we are serious about children’s health, we must address the root causes and restore transparency, consent, and personal choice in our public health decisions. This is why I’m running HB2396 to prohibit fluoride from being added to public water systems. 

Michele Reneau

TN State Representative

District 27