Robert F. Kennedy Jr.’s goal of eliminating fluoride from the water supply faces challenges no matter what role he plays on health care in the new Trump administration.

Days before President-elect Trump’s election, Kennedy wrote on social platform X that “the Trump White House will advise all U.S. water systems to eliminate fluoride from public water.”

But water fluoridation is a local government decision, and it’s unclear whether Kennedy could force municipalities to remove the cavity-fighting chemical.

It is also unclear whether Kennedy will have a formal role in the Trump administration, although he has been discussed as a potential Health and Human Services (HHS) secretary, and Trump has said he would let the former independent presidential candidate “going wild” about public health.

Kennedy wrote that fluoride was “associated” with a host of medical problems, although many of these claims are linked to exposure to fluoride doses far higher than most people would experience from drinking water fluoridated and brushing your teeth.

Fluoride is a natural substance that helps prevent tooth decay by strengthening and rebuilding weakened tooth enamel. Water fluoridation has been practiced in the United States since 1945.

Although Trump has not yet clarified what role Kennedy will play in his second administration, he did not dismiss the idea of ​​eliminating fluoride, saying it “sounds acceptable to me.”

A local decision

The Centers for Disease Control and Prevention (CDC) states online that “state and local governments decide whether to implement water fluoridation.”

The CDC has hailed water fluoridation as one of the 10 greatest public health achievements of the 20th century because of its effect on drastically reducing tooth decay.

No federal law requires water fluoridation, although some government agencies provide limits and recommendations on the amount of fluoride that can or should be present in drinking water.

“Fluoride is an example of a hyper-local decision. Even within states, most local authorities decide whether or not fluoride is added to water. This is now a policy decision that can be made at any level of government,” Chrissie Juliano, executive director of the Big Cities Health Coalition, told The Hill.

The United States Public Health Service recommends fluoride levels – a maximum of 0.7 milligrams per liter – for maximum oral risk and reduced potential harm, but these standards are not enforceable and all water fluoridation in community systems is carried out voluntarily.

Possible paths to a ban

The incoming Trump administration could theoretically use the Toxic Substances Control Act of 1976 (TSCA) as a means to ban water fluoridation. TSCA grants the Environmental Protection Agency (EPA) authority to regulate chemicals in the United States.

“The new administration, with or without RFK’s influence, could seek to ban water fluoridation, or review fluoridation levels, through several avenues, including TSCA. Whether or not this will be the case remains to be seen, as the legal and public health implications of ‘banning’ water fluoridation are significant,” said Lynn L. Bergeson, managing partner of the law firm. Bergeson & Campbell.

The Trump administration could also limit water fluoridation through the Safe Drinking Water Act of 1974, which gives the EPA the authority to regulate water quality in all states.

“The federal government could likely review the Safe Drinking Water Act’s maximum contaminant level for fluoride in drinking water and effectively ban fluoride. Not quick or easy, but an option,” Bergeson said.

“HHS should, once again arguably, revisit its recommendation that the current level of fluoride in drinking water…is desirable, as the (American Dental Association) reaffirmed in its Sept. 25 statement, to prevent tooth decay,” she added.

“Pursuing such an option is likely to generate significant backlash as well as praise, despite the largely unquestioned support that fluoridated drinking water has enjoyed for decades. »

Previous legal challenges

The EPA sets legal limits for 90 different contaminants in drinking water, including fluoride.

According to EPA standards, drinking water cannot contain more than 4.0 mg/L of fluoride, with the agency citing bone disease and the possibility of staining children’s teeth as potential long-term effects. on health.

Those standards were challenged in a 2017 lawsuit filed by a coalition of groups opposed to water fluoridation, claiming in their complaint that the chemical caused negative neurological impacts in humans.

The federal judge presiding over the case, Edward M. Chen, an Obama-appointed U.S. district judge, earlier this year ordered the EPA to look into the potential impacts of fluoride in drinking water on water levels. QI, writing that there was an “unreasonable risk” from fluoride in the drink. water.

Chen also noted, however, that his unreasonable risk conclusion “does not conclude with certainty that fluoridated water is harmful to public health; on the contrary… the Court considers that there is an unreasonable risk of such harm.

The lawsuit was filed after the EPA denied a citizen petition filed by the plaintiffs, which TSCA allows following a 2016 Congressional amendment.

Bergeson said she does not interpret the law to mean that a citizen petition and subsequent judicial appeal can replace chemical risk assessment.

“The implications of risk management regulation through this route lead to a ton of unintended consequences and EPA budgetary and programmatic anomalies,” she said.

The National Toxicology Program (NTP) under the Department of Health and Social Services published the findings from its own assessment earlier this year of the impact of fluoride on neurodevelopment and cognition

The NTP concluded that “higher levels of fluoride exposure, such as drinking water containing more than 1.5 milligrams of fluoride per liter, are associated with lower IQ in children.”

“It is important to note, however, that there was insufficient data to determine whether the low fluoride level of 0.7 mg/L currently recommended for U.S. community water supplies has a negative effect on children’s IQ,” the NTP added.

Ongoing debate

According to Myron Allukian, a dentist for more than 50 years and former president of the American Public Health Association, concerns and conspiracies around water fluoridation have existed for decades.

Allukian, who chaired the U.S. Surgeon General’s Task Force on Fluoridation and Dental Health for the Nation’s 1990 Prevention Goals, was involved in early efforts to get cities like Boston to adopt dental fluoridation. water.

“When I started, you know, they thought it was a communist plot. And there was a very active movement for this measure on the part of the communists,” Allukian said, recalling his later meeting with a Soviet Union health official who said people in his country believed that fluoridation was a capitalist project.

“The people who oppose it have looked for different reasons to oppose it,” he said.

Allukian, former dental director for the city of Boston, said a fluoride-free environment would cause problems with bones and teeth because the chemical is a natural component of those parts of the body. He also pointed out that fluoride occurs naturally in waterways and therefore fluoride-free drinking water is not a realistic goal.

Jeffrey A. Singer, a surgeon and senior fellow at the libertarian think tank Cato Institute, doubts studies linking fluoride to adverse effects like lower IQ.

“These are very poor quality studies,” Singer said. “Most of them are just observational studies and, you know, correlation is not causation. And in fact, most of them use IQ as evidence of neurotoxicity and IQ is not a good metric for measuring neurotoxicity.

Singer opposes the addition of fluoride to the water supply, although his position has more to do with his belief in the doctrine of informed consent.

Linda Birnbaum, a former federal EPA scientist, also opposes water fluoridation because she believes the evidence strongly supports against the practice, particularly early in life and during pregnancy. Birnbaum was also director of the NTP as well as the National Institute of Environmental Health Sciences.

“I think what happened is that for the last 60 years the only source of fluoride that most people were getting was from their drinking water, up until now people are getting fluoride every time they brush their teeth or use mouthwash,” Birnbaum said.

“So the benefit to everyone of drinking fluoridated water, as far as preventing cavities, is no longer clear as before, and I think there is growing evidence that ‘in fact, it may no longer be very useful.’

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