Robert F. Kennedy Jr., President-elect Donald Trump’s pick to oversee the Department of Health and Human Services, has called for an end to adding fluoride to public water supplies. Though Trump has not formally announced a position on the topic, he has said he intends to let Kennedy “run wild” on public health issues.
But would Kennedy have the authority to ban fluoride from the tap? It’s unclear. And the path toward doing so is even muddier.
That’s because what goes into public water systems is a decision made at the municipal level rather than by the federal government.
“In Pennsylvania, the decision to use or not use fluoride in water is a public water system’s decision,” said Lauren Camarda, a spokesperson for Pennsylvania’s Department of Environmental Protection (DEP).
There are more than 1,800 community water systems in Pennsylvania, and only about half of them add fluoride during their treatment process. Several suburban water systems surrounding Pittsburgh, including Shaler, Hampton, Sharpsburg and Moon Townships, do not add fluoride to the water. Any changes to that process also require a significant operations permit change that must be approved by the DEP.
That said, in September, federal U.S. District Judge Edward Chen ordered the EPA to further regulate fluoride in drinking water to reduce any risks. While that order stopped short of identifying specific measures that should be taken, it could streamline anti-fluoridation efforts. A New York City suburb cited the ruling as the basis for its move to ban the additive.
Fluoride is a naturally occurring mineral that strengthens teeth and reduces cavities by replacing minerals lost during normal wear and tear, according to the Centers for Disease Control and Prevention. The agency has found that the additive can reduce cavities by 25% in children and adults. The addition of small amounts of fluoride to drinking water has been hailed by health officials as one of the greatest public health achievements of the last century.
A 2018 study from the University of North Carolina at Chapel Hill School of Dentistry found that counties where more than 75% of the population had access to fluoridated water saw a 30% decrease in tooth decay in kids between the ages of 2 and 8, compared to county populations which had less access to fluoridated water.
But an August report by the National Toxicology Program shows a link between excessive levels of fluoride and lower IQ in children. The conclusions were based on children exposed to twice the recommended limit set by the U.S. government and the report did not draw conclusions about whether there were risks associated with lower levels of fluoride.
Fluoride remains popular at Pittsburgh water systems
Both major drinking water providers in Pittsburgh — Pennsylvania American Water and Pittsburgh Water — treat their water with fluoride. Pittsburgh Water, which serves 500,000 customers, adds fluoride to the water during one of the final stages of treatment at its facility in Pittsburgh near Aspinwall. More than 90% of water systems in Allegheny County are treated with fluoride.
According to Frank Sidari, Pittsburgh Water’s chief environmental and compliance officer, the company’s water treatment plant draws in about 65 million gallons of water from the Allegheny River per day. To that, it adds between 100 and 200 gallons of fluoride in the treatment process during the disinfectant stage.
“We add fluoride basically right before the water is ready to head out into the distribution system after it's been through our entire treatment process,” Sidari said.
Pennsylvania American Water adds water at some of its treatment facilities but not all of them. The company declined an interview request, but said in a statement that it would continue to follow state regulations and the will of its municipalities when fluoridating water.
“Pennsylvania American Water follows the direction of the Department of Environmental Protection and local communities regarding whether fluoride is added to the water supply,” the statement reads. “Should local or state regulations change, the company will modify its treatment accordingly to comply with revised regulations.”
At Pittsburgh Water, automated pumping systems add about 0.7 milligrams of fluoride per liter of water, which, according to the CDC, is equal to about 3 drops of water in a 55-gallon barrel. The company has been adding fluoride to the water since the 1950s. Sidari said the dental hygiene provided by the additive can improve health equity “especially in groups that may not have the best access to dental hygiene or might not have the best access to fluoridated toothpaste.”
“Being able to kind of have this universal ability to provide fluoride in the water to those types of groups may be helpful in those cases.”
Despite evidence and concerns, any changes to the current fluoridation process would likely be slowed by bureaucratic red tape. The process is intentionally slow and methodical, Sidari said, pointing to the recent Environmental Protection Agency requirements mandating water companies replace service lines containing lead within the next ten years.
“It's not just tomorrow we stop [adding fluoride] kind of thing,” he said. “I would expect a similar process unless things are drastically different than the previous status quo.”
Whether the public health policies of the second Trump administration will challenge the status quo when it comes to water quality remains to be seen. Kennedy must be confirmed by the Senate before he can take the reins as HHS secretary.
For Sidari, he’s optimistic that any new federal recommendations would be strongly backed by scientific evidence. And he doesn’t expect change to come quickly.
“Making a drastic change in how we treat the waters generally, something we don't want to do,” Sidari said. “We want to make sure that there are measured changes.”
