For This Rural Town, a Fluoride Debate Is About More Than the Water

Since fluoride was first added to the water system of Grand Rapids, Michigan in 1945, the practice has been controversial. The American Dental Association (ADA) claims that even though fluoride is present elsewhere such as in some toothpastes, water fluoridation reduces tooth decay by at least a quarter regardless of age. The ADA also claims it is safe at optimal levels and saves more money in treatments than it costs for most cities. Some, like the Fluoride Action Network (FAN), oppose public water fluoridation. FAN claims that fluoride is toxic and can damage health including causing thyroid and gastrointestinal problems, hypertension and joint pain.

Opposition to water fluoridation by federal and local government officials has made headlines recently. The U.S. Centers for Disease Control and Prevention currently supports the addition of fluoride to public water systems. But Robert F. Kennedy, Jr., the U.S. Secretary of Health and Human Services, has made it clear that he wants to change this position. His department has announced that a Community Preventive Services Task Force will review the use of fluoride. This spring, the U.S. Food and Drug Administration began working to ban the sale of prescription fluoride products designed to be swallowed by children. In July, it held a meeting to hear from experts and the public on this effort and aims to conclude this initiative by the end of October.

This year, Utah and Florida banned the practice of fluoridating water, and several other states–including Louisiana, Kentucky, Minnesota, Arkansas and South Dakota–have considered legislation to change their fluoridation practices. And in May, the Texas Attorney General began investigating the Colgate-Palmolive Company and the Proctor & Gamble Manufacturing Co. alleging their marketing causes children to ingest fluoridated toothpaste and parents to use more than necessary.

As the WUD board and attendees expressed their views, it became clear that disagreement about fluoridation was a symptom of competing ideological beliefs that fuel a range of national disputes. The meeting itself and the fluoride debate more generally provide a microcosm of differing beliefs on the appropriate role of social media as a news source, the prudence of trusting experts and the government, and the balance between personal rights and the community’s needs.

According to a Pew Research Center September 2024 fact sheet, about half of Americans report using social media as a news source “sometimes” or “often.” That is how the morning’s discussion in Woodlawn began. A WUD employee played two YouTube videos about the dangers of fluoride. In one, a Detroit-area periodontist and media personality discussed studies on possible side effects of fluoridation, including kidney and liver damage in young people and lower IQs in children. Some dismissed this information. A dentist worried that “rumors such as internet videos” would convince parents fluoride is harmful. Two attendees challenged IQ studies they claimed weren’t based on enough evidence or weren’t peer-reviewed.

Disagreement about the validity of information found on social media is commonplace, and it isn’t limited to the content. Opinions vary on the effects of these sites’ involvement in curating and presenting that content. The fluoride debate is no exception. Dr. Dominik Stecuła, assistant professor of communication and (by courtesy) political science at The Ohio State University, says that in the mid-2000s to mid-2010s, social media sites, including YouTube, changed their algorithms to recommend content to users. This created an environment where content that contained “loaded” or emotionally charged language thrived, promoting “algorithmically amplified misinformation.”

“Misinformation about public health measures was amplified during the Covid-19 pandemic and became politicized fast,” he says. “Sadly, it has extended to other areas, including water fluoridation.” While sites began fact-checking during the pandemic to combat misinformation, Stecuła notes that some have abandoned this role. “They’re no longer interested in trying to kind of safeguard at least medical misinformation,” he says.

Stuart Cooper, an opponent of fluoridation and executive director of FAN, has a different view of social media companies’ involvement in content selection. “Social media, for a long period of time, censored our work and without explanation,” he says. “And it was really unjust and unethical.” According to him, FAN initially grew due to social media. But he says when sites like Facebook and YouTube changed algorithms, he noticed changes to FAN’s accounts: a decrease in views, an equal number of people who subscribed and unsubscribed per week and less prominent positions for their materials. He welcomes Elon Musk’s X, formerly Twitter, because “it allows free speech,” but he emphasizes that FAN began long before social media. “And that’s the sad part about it is if people listened to us 15 years ago, think how many millions of children wouldn’t have been sacrificed for the American Dental Association.”

The debate on what constitutes valid information is linked to another conflict apparent in the Woodlawn Utility District meeting: whether to trust experts and the government or make one’s own decisions. Dentists promoted fluoridation by describing their experiences with patients. One public health official cited health authorities such as the Tennessee State Dental Director. But one anti-fluoridationist asked, “How fair is that for the government just to tell us what we need? We’ve seen that in the past five years,” he said. “And if you don’t agree with that, well, I think you’re pretty uneducated, regardless of what degree you may have.”

Barbara Sturgeon, a commissioner in Williamson County, Tennessee, just south of Nashville, also refers to recent experience to explain her opinion on fluoridation. Earlier this year, the commission voted on a resolution to support legislation in the Tennessee Senate and House that included a reduction in the amount of fluoride in water that would trigger monthly testing and a ban on water fluoridation in the state. Sturgeon voted in favor of the resolution. “Considering what we just went through with Covid,” she said. “I don’t think we can just trust, quote, experts anymore.”

According to Dr. John Geer, distinguished professor of political science at Vanderbilt University, distrust in the government is a national trend. “That’s been a sea change in public opinion over the last 60 years … ” he says. “So if you don’t trust the government, why trust them about fluoridation?” Cooper believes that FAN’s supporters, which include dentists, aren’t inherently doubtful of official positions but have diverse beliefs and are united by their opposition to fluoridation. But he also stresses that these supporters are people who initially accepted what they were told but then researched for themselves.

In the WUD meeting, personal choice and an individual’s rights clashed with the community’s interests. Fluoridation opponents argued that by fluoridating public water, consumers can’t choose to avoid it. Others argued to keep fluoridation for populations like the elderly that might not have other dental care options. A hygienist who worked at Woodlawn Elementary School explained her pro-fluoridation stance by describing the dental problems she’s seen in students. A retired teacher argued for fluoridation because everyone has water. She described learning as a first-year teacher that many of her students were not brushing at home so she bought toothbrushes they could use at school. The WUD general manager said he believed that dental supplies and services are available to everyone. “Now we got to put some responsibility on the customer or the people,” he said. “We can’t provide everything for everybody.”

Cooper agrees. Referring to the manufacturing of most water treatment fluoride he says, “Those screechers in those communities like Buffalo,” then sarcastically, “ ‘if I don’t get phosphate fertilizer hazard waste, what is my child gonna do? Oh my God!’ Hey, you can get toothpaste for a dollar at the dollar store.” According to local news reports, Buffalo, New York, stopped adding fluoride to its water in 2015, only announcing the change in water reports. This was discovered in 2023, and parents sued for their children’s dental problems. The city restarted fluoridation in September 2024.

The creation of most fluoride involves processing the mineral apatite, which contains calcium phosphate, until gases are produced from which phosphate and fluoride condense. The phosphate can then be used to make fertilizer. The American Academy of Pediatrics rejects the claim that fluoride is waste or a fertilizer byproduct, contending that those against fluoridation say this to mislead people into believing fertilizer is the source of fluoride. It also notes that phosphoric acid used in Coke and Pepsi also comes from the same source as fluoride.

Sturgeon summed up her view of this tension between the individual and the community: “They believe it’s better to take away my choice for the benefit of the person at the bottom of the rung of the ladder … So it’s a philosophical difference of opinion.”

In the end, the two voting board members present voted to stop fluoridating Woodlawn’s water supply at the start of 2025. The Tennessee Senate bill died in committee. A Tennessee House bill that still includes a fluoridation ban was deferred to next year. And the discussion continues. Sparta, a small city almost two hours east of Nashville, is currently considering ending fluoridation and will vote later this summer.

The debate on fluoridation also continues across the country. But exploration of the topic will be incomplete if these ideological issues underpinning it are ignored in favor of a purely scientific discussion. In their 2009 book, The Fluoride Wars: How a Modest Public Health Measure Became America’s Longest-Running Political Melodrama, R. Allan Freeze and Jay H. Lehr argued that concerns about fluoridation have changed over time, matching the worries of each decade.

Stecuła believes that’s true for our time as well: “For the most part, the debate fits within just our moment right now of low trust, of dislike of experts, of populism, and just trying to look for kind of simple solutions to complex problems.”

Maggie GigandetMore by this author →

Maggie Gigandet is a Nashville freelance writer focusing on the outdoors and people with unique passions. Her work can be found in The Atavist, Backpacker, Atlas Obscura and Smithsonian Folklife. Visit maggiegigandet.com for more work.