RFK Jr. wants to ban common yet controversial practice of adding fluoride to drinking water

An unexpected consequence of Donald Trump‘s election as US president was the return to public debate of an old American public health measure: Water fluoridation. Robert F. Kennedy Jr, set to become the health secretary, is not only a notorious anti-vaxer but also a fierce opponent of adding fluoride to drinking water. He claimed that the practice is “associated with arthritis, bone fractures, bone cancer, IQ loss, neurodevelopmental disorders, and thyroid disease.”

While some of these claims are unsupported by scientific evidence – notably the link between fluoride exposure and cancer – a growing number of scientific studies and official reports are questioning the relevance of this practice, which remains in force in 24 countries around the world, including Australia, Canada and Malaysia, but is virtually non-existent in Europe.

In the US, 62.8% of the population has access to fluoride-supplemented tap water. The decision to add fluoride salts, such as sodium fluoride (more readily soluble than natural calcium fluoride), or other compounds such as fluorosilicic acid or sodium fluorosilicate, is made at the local level, usually by municipalities.

This practice gained popularity in the United States after the Second World War as a means of fighting tooth decay. Fluoride has the unique property of binding to tooth enamel, reinforcing this natural mineral barrier against cavity-causing bacteria. Numerous studies have since demonstrated its effectiveness in fighting this extremely common dental infection. So much so, that in 1999, the Centers for Disease Control and Prevention (CDC) listed water fluoridation among the top 10 public health achievements of the 20^th century in the US.

But it’s all a question of dosage. Consumed in excessive quantities, particularly during childhood, fluoride can cause white or even brown stains on tooth enamel, making them brittle – a condition known as fluorosis. In very high concentrations, fluoride can also bind to bones and stiffen joints. This is why the World Health Organization (WHO) has set 1.5 milligrams per liter (mg/L) as the threshold above which fluoride concentrations – including natural levels – can be harmful. In the US, the historical recommendation was to maintain fluoride levels between 0.7 and 1.2 mg/L, until a 2015 revision set 0.7 mg/L as the “optimal fluoride concentration” in response to increasing cases of fluorosis in the country.

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