Since 1951, the surgeon general has endorsed the practice of adding fluoride, a naturally occurring mineral that protects against tooth decay, to community drinking water. Now, the U.S. Public Health Service, overseen by the surgeon general, recommends lowering the amount of fluoride added to drinking water, due to the fact that many people are getting too much fluoride through their toothpaste and other products.

This downward change is a first in more than half a century. Currently, about 200 million Americans drink fluoridated water through the 12,341 community water systems that add fluoride to the drinking supply (or purchase water from other systems that do so).

Adding fluoride to community water is a criticized practice both in the U.S. and worldwide. Only about six percent of the world’s population drinks fluoridated water, with 97 percent of all people living in western Europe drink non-fluoridated water. Germany, Japan, Sweden, Switzerland, and Israel are among the countries that have discontinued or outright banned the practice. Some countries view fluoridation of water as a form of "compulsory medication."


In 1945, Grand Rapids, Michigan, became the first city in the world to add fluoride to its drinking water. While most water contains naturally occurring fluoride, the levels are usually too low to prevent tooth decay. For this reason, many communities adjust fluoride concentrations to a beneficial level as a way to promote good oral health. In fact, six years after Grand Rapids began fluoridating its water, a study found a significant decline in tooth decay among children residing in the area.

Since 1962, the government has been advising water systems to add fluoride to a level of 0.7 parts per million for warmer climates, to 1.2 parts per million in cooler areas. The new standard is 0.7 everywhere.

Health officials noted that too much fluoride causes white splotches on children’s teeth. Toothpaste containing fluoride was first marketed in 1955 and by 1983, almost 70 percent of very young children (under age 4) and more than 90 percent of older children and teens used fluoride toothpaste. By the 1990s, fluoride toothpaste accounted for more than 90 percent of the toothpaste market, while other products, including mouth rinses and dietary supplements, also provide fluoride.

The downward change was first proposed four years ago and since then the government reviewed 19,300 public comments.

“Nearly all submissions opposed community water fluoridation at any concentration; they stated that the new recommendation remains too high, and most asked that all fluoride be removed from drinking water,” states the government report.

Controversy has always accompanied fluoridated drinking water programs, with many citizens continuing to fight what they see as an outmoded practice. “The most obvious reason to end fluoridation is that it is now known that fluoride’s main benefit comes from topical contact with the teeth, not from ingestion,” notes Fluoride Action Network, while adding, “the most important reason to end fluoridation is that it is simply not a safe practice, particularly for those who have health conditions that render them vulnerable to fluoride’s toxic effects.”