Fluoridation: Essential Part of Water Treatment or Unwarranted Addition?

On February 8, 2024, the Kentucky House Standing Committee on State Government voted 16 – 1 in favor of sending HB 141 on to the House floor for consideration. HB 141 is an act relating to water fluoridation programs in Kentucky. In summary, the bill would amend KRS 211.190 to make water fluoridation optional for water systems and allow the governing bodies of those water systems to decide whether they wanted to participate in the water fluoridation program. It would also prevent consecutive water systems served by the supplying system from forcing the supplier to provide fluoridated water.  

Currently, under 902 KAR 115:010, any water system in Kentucky serving a population of 3,000 or more must supplement their finished water with fluoride if it is naturally fluoride deficient. The range of fluoride in finished water should be between 0.6 ppm and 1.2 ppm with a target goal of 0.7 ppm. This and similar bills have been introduced previously but have never made it through or passed the committee stage with such an overwhelming majority. The lopsided vote in favor of changes has garnered a lot of conversation and responses from both those in favor of the bill and those in opposition.    

The Kentucky Dental Association (KDA) sent a letter to the House Standing Committee opposing HB 141. The KDA explains in the letter, “Over 70 years of research and practical experience, the overwhelming weight of credible scientific evidence has consistently indicated that fluoridation of community water supplies is safe” and “the cost of a lifetime of water fluoridation for one person is less than the cost of one filling.” The Centers for Disease Control and Prevention (CDC) has named water fluoridation as one of the ten great public health achievements of the 20th century.   

According to the CDC, access to fluoridated drinking water reduces cavities by about 25% in children and adults.  Many of the benefits from drinking fluoridated water include strengthening of developing permanent teeth in children eight and under and supporting healthy tooth enamel in adults, along with fewer cavities for all. Both the CDC and KDA show that 95% or more of Kentucky residents receive fluoridated water. In fact, the CDC ranks Kentucky second, only behind the District of Columbia, in percentage of the population receiving fluoridated water. More information and state statistics can be found on the CDC Community Water Fluoridation page at Community Water Fluoridation | Division of Oral Health | CDC.   

Other groups and individuals have taken a stance of support for HB 141. Soon after the bill passed the committee, the group Kentucky for Fluoride Choice released a letter citing several research articles and opinions from water professionals on the possible dangers of fluoride which they believe could be linked to negative health outcomes. Other concerns from the group include the source of additive fluoride. Many water systems use hydro fluorosilicic acid (HFS), an industrial waste byproduct of the phosphate fertilizer and aluminum industries and is not a naturally occurring chemical. More information can be found on their press release at KFFC Press Release for KMFC Website. 

Water treatment operators, the ones on the front line of this debate who are handling and dosing fluoride for their customers, have brought up the subject many times recently during site visits and at training sessions conducted by Rural Community Assistance Partnership (RCAP) Technical Assistance Providers (TAPs).  Although they are proud of the fact that they play such an important role in dental health for their communities and they take that role very seriously, many have concerns about water fluoridation as well. Most topics of concern include those previously mentioned: 

• Forced medication 

• Fluoride not being necessary for making water safe to drink 

• Hazards of handling HFS and other fluoride additive chemicals 

• Possible side effects of fluoride 

As of this writing, it appears that HB 141 will not make it to the House floor before the session expires. However, we can be sure that some form of the bill will come up again soon. As TAPs, we should research both sides of the fluoride debate and be prepared to give advice to operators if asked. At a minimum, it is our responsibility to make sure that small, disadvantaged systems and their operators get the training to be able to safely handle and dose the recommended amount of fluoride and, if a change is made, be prepared to assist in communicating to the public fluoridated water alternatives.   

This article was funded under RCAP’s EPA NPA 1 2023 – 2025 grant.