Fluoride Is Great for Teeth, But Is It the Government's Job to Fluoridate Water?

President Trump's second term has been shaped by controversial decisions, including making English an official language, imposing tariff rates we have not seen in over a century, deporting undocumented workers, and using price controls on prescription drugs. Out of his confirmations, I would contend that the most controversial of all of them is Trump's Secretary of Health and Human Services, Robert F. Kennedy Jr. Kennedy has spoken out against vaccine safety, opined that vaccines cause autism, and he even said that COVID was "ethnically targeted" to spare Ashkenazi Jews and the Chinese, as if viruses are capable of targeting a specific ethnic group. 

Kennedy's vision for what he would like to do as HHS Secretary is detailed in his Make America Health Again (MAHA) report. One of the major controversies that Kennedy has managed to drudge up is his take on fluoride. Kennedy has long been against the practice of fluoridating water, calling it "industrial waste." He even tried urging Trump to advise U.S. water systems to remove fluoride from their water treatment. The topic caught my eye enough to blog on the topic because I noticed that the Food and Drug Administration is proceeding with its plan to ban prescription fluoride supplements. Opposition to fluoride is nothing new. This opposition dates back to the 1940s, which is when the practice of water fluoridation emerged. It also made an appearance in the 1964 film Dr. Strangelove. 

Analyzing the Health Implications

One of the main reasons for opposition to water fluoridation is for health concerns. The question is whether fluoride actually has unintended health consequences. The meta-analysis that recently made the news shows that, at worst, the decline in pediatric IQ from fluoridation is 1 to 2 points (Taylor et al., 2025). It is worth pointing out that the fluoride levels studied in that controversial meta-analysis were double the recommended amount in U.S. federal guidelines. There is also no link shown between fluoridation and cancer. The National Toxicology Program's 2020 review concluded that high levels of fluoride exposure were problematic, but found scant evidence of harm in the lower levels used in fluoridation.  

While there are some gaps in the research (particularly for larger doses of fluoride), what we know with the best available research is that fluoridation in small doses is shown to have benefits. My support is not mere opinion. It is supported by the American Dental Association, Centers for Disease Control and Prevention (CDC), World Health Organization (WHO), and Royal Society for Public Health have all advocated for water fluoridation. There is no credible scientific body that currently advises against the practice of water fluoridation.

The strengthened tooth enamel with fluoridation reduces the rate of tooth decay (Nassar and Brizuela, 2023), which could be a reduction of tooth decay as much as 25 percent. This, in turn, reduces the needs for fillings, root canals, crowns, and other dental expenses. The primary reason that fluoridation of water became a practice is because it has been widely accepted as a cost-effective public health measure to mitigate cavities, tooth decay, and dental disparities. All else being equal, fluoridated communities have lower rates of dental decay.

Here is my "on the other hand" argument. There are certain countries that have fluoridated their water, such as the United States, United Kingdom, Ireland, Hong Kong, and Australia. However, the vast majority of countries on the planet have not done so. A study from the 20th century shows that countries that failed to adopt water fluoridation experienced comparable declines in dental decay to those that did fluoridate (Diesendorf, 1986). As you can see from the World Health Organization's report on oral health, there are countries without water fluoridation that enjoy comparable dental health to those that do. 

The maps above give me at least some pause because one could argue that diet, oral hygiene practices, and access to dental care also play a role in dental health. On the other hand, there is an argument to be made that water fluoridation is a helpful public health measure. For argument's sake, let us assume that fluoride unquestionably has positive health benefits. Should the government still be fluoridating water? 

Ethical Issues

My biggest issue with the government fluoridating water has to do with informed consent. As long as you are not hurting somebody else, you should be able to get to decide what substances you consume, regardless of what a healthcare provider might recommend. To give you a sense of how I take it seriously, I have advocated for consumption of marijuana and of psychedelic mushrooms, engaging in sex work, not being forced to take a COVID vaccine, selling one's organs for cash, adults having consensual sex with whichever adults they want, eating and drinking what you want (including raw milk and processed foods), and using birth control. In this respect, mandated water fluoridation violates the concept of bodily autonomy.  

People should be responsible for their own personal dental health, whether that is a healthy diet or proper brushing technique. Even if the decision to fluoridate water made sense in the mid-20th century, it does not make as much sense in 2025. Those who want to use fluoride for dental health have multiple ways to do so, including fluoride toothpaste, fluoride mouthwash, supplements, varnish, and fluoridated salt. The challenge with these alternatives is that they require consistent usage, access to resources, and dedication. Conversely, an advantage of water fluoridation is that it is a passive, population-wide baseline of protection that is more reliable. 

I would be more inclined to support water fluoridation if there were a robust opt-out system. Even as I supported the COVID vaccines in 2021, I still have believed that mandating the vaccines was unnecessary (see here, here, here, and here). Vaccines have a viable way to opt out of getting vaccines. One could argue that it is possible to opt out with fluoridation, whether through bottled water, purified water, or purchasing a water purifier. There are also the possibilities of implementing free access to non-fluoridated water, subsidized filters, or financial assistance for those who cannot afford bottled or purified water, although these options would all but inevitably involve at least some government intervention.Plus, keep in mind theCareQuest Institute for Oral Health released a survey last month showing that only 6 percent believe that water fluoridation should be banned. While it is cumbersome, you would think that those who are the most against water fluoridation would have already implemented these workarounds. Even with the default being fluoridated water, there is still autonomy for the individual to change it if so desired. 

I would also point out that a private company entering the market to provide a non-fluoridated option is impractical, at least in a U.S. context. Building parallel water delivery systems, e.g., pipes, pumps, treatment facilities, is prohibitively expensive. Zoning and utility regulations, along with public utility commissions, de facto block new entrants from entering the market. Plus, there is not much in the way of market demand for a private company to enter the market simply to provide non-fluoridated water. As such, water utilities is one of the notable exceptions in which a government monopoly makes the most sense. Since water utilities end up being a natural monopoly, someone has to decide how the water is treated, which brings us to the next section. 

Individual and Public Healthcare Costs Due to No Water Fluoridation

I think back to when I made a libertarian argument last March in favor of the government supporting the PEPFAR program for HIV/AIDS prevention. I could make a similar argument for water fluoridation. Fluoridating water is a minimal intervention and has a high return on investment. This would explain why the CDC estimates that $1 spent on fluoridation saves about $20 in dental costs, whereas the ADA estimates that it is high as $38 in savings per dollar spent. 

More to the point, this relatively small intervention can save us the headache of more government intervention down the road. If you remove water fluoridation, it could lead to an expansion of Medicare and Medicaid dental coverage, new health care regulations, a federal mandate for dental insurance coverage, dental care subsidies, or price controls similar to the ones that President Trump imposed on prescription drugs earlier this year. Fluoridation falls into a rare category of public policy intervention that paradoxically protects liberty by preventing greater government intrusion.

The reality is that the United States does not have a free-market healthcare system. Healthcare in the U.S. has major elements of socialization with such programs as Medicare, Medicaid, and the Veterans Affairs healthcare system. Since healthcare costs are socialized in this country, the aggregation of poor dental practice can add up quickly. This argument is significant since 51 percent of Americans brush twice daily, which is the amount recommended by the American Dental Association. If a third cannot follow these basic protocols, what are the odds that they would make sure they are taking fluoride alternatives consistently enough to make a difference?

That behavioral failure is a problem in a healthcare system in which healthcare costs are socialized. The fact that about half of Americans cannot manage basic dental hygiene means that non-intervention also has hidden costs. One study estimated that water fluoridation saves the United States $6.5 billion annually [in 2013 dollars] (O'Connell et al., 2016), which would be $8.9 billion in current dollars. Removing water fluoridation would contribute to rising health care costs, much like we have seen take place with obesity raising healthcare costs for all. 

Should the Government Fluoridate Water?

I struggled writing this piece because both sides of the water fluoridation debate make compelling arguments. I genuinely respect individual autonomy and I am an advocate for limited government (emphasis on the word "limited"). Especially with alternatives such as fluoride toothpaste, I take issue with the violation of bodily autonomy. While I understand the ethical implications of mandating water fluoridation, they also become less persuasive given the size of the public benefit of water fluoridation and the existence of workarounds for water fluoridation. Plus, fluoridation has been implemented for over eight decades and it has not resulted in mass medication or erosion of medical autonomy on the whole, thereby negating the slippery slope argument. 

As difficult as it is for me to say, I have to say that water fluoridation is warranted given the circumstances, even from a libertarian lens. I remind myself that there have been other warranted interventions similar to water fluoridation, including water chlorination to prevent cholera and typhoid; iodized salt mandates to address iodine deficiency; traffic signals that lower accidents; and seatbelt laws to reduce fatalities and injuries from automobile accidents. I am not necessarily defending these examples on moral grounds per se, but rather showing that there is a long-established precedent of minor health-protective interventions with a significant return on investment (ROI).

In a country where dental costs are socialized through Medicare and Medicaid, the collective financial burden of preventable dental disease justifies this minimal, narrowly tailored, low-cost intervention tied to a shared resource. The intervention is tightly defined, the evidence base is solid, and the ROI is high. Water fluoridation is a pragmatic approach that recognizes real-world trade-offs while preventing the need for far more exorbitant, intrusive, and coercive government intervention in the future. Since some government action is inevitable, the least intrusive option that yields measurable benefits is preferable to a more coercive alternative. 

Much like I realized when arguing in favor of PEPFAR last March, this conclusion is not a perfect fit with libertarian ideals. In an ideal world, I would like for there to be no government intervention and for the healthcare market to be privatized. However, a world with more limited government is best achieved in practice when balancing principles with real-world application to find the "least worst intervention" in a deeply flawed healthcare system, especially when considering that water utilities are operated as a natural monopoly. Having the government fluoridate water is not a betrayal of liberty in this case because a modest, limited, and well-tailored intervention in an imperfect world beats the alternative. Given the realities of the water market and the science of fluoridation, the pragmatic libertarian in me would rather support a minimal, practical compromise that helps preserve liberty in the long-run than allow for an alternative that allows for government largesse to proliferate even further. 61 percent of Americans brush at least twice daily