Florida surgeon general’s fluoride guidance risks children’s health, experts say

TAMPA — New guidance from Florida’s top health official could lead to an increase in cavities and other dental issues, especially among children and low-income communities, health experts are warning.

Florida Surgeon General Joseph Ladapo last month advised communities against adding fluoride to their drinking water citing studies in Canada and Mexico that found a correlation between high levels of the chemical and lower IQ scores in children.

It comes after Robert F. Kennedy Jr., President-elect Donald Trump’s pick for secretary of Health and Human Services, posted on social media that Trump would push to remove fluoride from drinking water on his first day in office. Several communities in Florida, including Collier County and the city of Winter Haven, had already bucked scientific consensus about the substance’s effectiveness in reducing tooth decay and have voted to stop adding fluoride to their water supplies. Naples could be about to join them.

But public health experts and dentists say the studies cited by Ladapo are based on exposure to larger quantities of the substance than the 0.7 milligrams of fluoride per liter of water that was set as the national drinking water standard in 2015.

Water fluoridation is supported by the American Dental Association, the American Academy of Pediatrics and the Florida Dental Association.

“It’s disheartening to hear Dr. Ladapo’s misinformed and dangerous comments regarding community water fluoridation,” American Dental Association president Brett Kessler, president of the American Dental Association, said in an email.

The Florida Dental Association sends member dentists and its own experts to local government meetings to advocate for the continuation of water fluoridation when the practice comes up for a vote.

“We find it discouraging to say the least,” Jeff Ottley, president of the Florida Dental Association, said of Ladapo’s new guidance. “Water fluoridation has been proven for over 75 years to be safe at optimal levels to reduce tooth decay by at least 25% in children.”

Ottley added that Florida has the second lowest reimbursement rate for dentists who treat children covered through Medicaid. It means very few dentists will take Medicaid patients.

Fluoride is a naturally occurring mineral often found in water at low levels. More than 70% of communities nationwide add fluoride to drinking water based on federal government recommendations first established in the 1950s. More than 70% of Florida communities follow those recommendations, according to Florida Department of Health data.

The U.S. Centers for Disease Control and Prevention called its contribution to the decline in cavities one of the 10 great public health achievements of the 20th century.

That success is because fluoride that is consumed through water is used by children’s body as they grow teeth, said Isaac Garazi, a dentist and the owner of Garazi Periodontics and Dental Implants in Miami. The mineral results in stronger enamel more resistant to the bacteria that causes decay.

Garazi pointed to the Canadian communities of Windsor and Essex, which in 2019 voted to put fluoride back in drinking water six years after removing the mineral. The decision came after local health organizations reported a 51% increase in the percentage of children who had either dental decay or needed urgent dental treatment over a two-year period through 2017 compared to the most recent years when fluoride was present in the water supply.

“As a dentist who grew up without this benefit, and has seen an entire generation grow up without dental decay, I say to dental schools and pediatric dentists, get ready; you will be in tremendous demand,” Garazi said.

Ladapo guidance cites studies in Mexico and Canada that showed a correlation between fluoride levels found in the urine of mothers during pregnancy and IQ levels of children measured when they were older. The Canadian study found a 4.49 point lower average IQ score among boys aged 3 and 4 born to mothers with elevated fluoride levels.

The Canadian study states that the findings show a possible case for reducing fluoride intake during pregnancy. The Mexican study concludes that more research is needed to determine the cause of high fluoride levels in urine.

Neither study calls for the end of water fluoridation.

Ladapo also points to a study that states that many municipalities in several European countries have stopped adding fluoride to their drinking water.

But Mary Rose Sweeney, a professor at the Royal College of Surgeons, Dublin and one of the authors of the study, disagreed with how Ladapo represented her work.

“As Dr Ladapo cited our 2018 report in his guidance document, I would like to point out that while several EU countries ceased adding fluoride to water, none of these countries cited evidence of harm or adverse effects as the reason for discontinuing the practice,” she said in an email to the Tampa Bay Times.

The study was funded was funded by the Irish Water Institute at Dublin City University where Sweeney previously worked as a professor. It calls for caution by those considering the merits of water fluoridation.

“Politicians/elected representatives should act on evidence before advocating for the removal of fluoride from community water schemes which could have potentially serious personal and economic consequences particularly for disadvantaged children,” it states.

Ladapo’s guidance also says that the wide availability of fluoride through other means, like toothpastes, mouthwash and in-office dental applications, may mean some pregnant women and children are receiving more fluoride than necessary.

But studies have shown that children in lower-income homes are less likely to brush their teeth regularly, meaning the removal of fluoride from drinking water would have a greater impact in those homes.

Gov. Ron DeSantis appointed Ladapo in 2021, the second year of the pandemic. Ladapo had made a name for himself with columns in the Wall Street Journal expressing skepticism about the safety of mRNA COVID-19 vaccines. As the state’s top health official, he was frequently gone against the consensus of medical science to back DeSantis, including recommendations against getting newer versions of the COVID-19 vaccine and supporting Florida’s ban on gender dysphoria treatment for children.

Ladapo’s guidance on water fluoridation is not binding. Decisions on what goes into drinking water supplies are the remit of elected officials in cities and counties.

Pinellas County commissioners voted 4-3 in October 2011 to stop adding fluoride to drinking water. The move made national headlines and was credited with causing the election defeat of two Republican commissioners who supported the measure.

The new board voted 6-1 to resume fluoridation in 2012. The lone nay vote came from Commissioner Norm Roche.

Now a Tallahassee resident, Roche said it was ironic to see that two big issues of his time in office — water fluoridation and the Rays stadium — are still being hotly debated a decade later.

His position remains the same, he said.

“Our task is safe, clean drinking water,” he said. “Anything added to that mission — a chemical or an additive — needs to meet the strictest of standards and be subject to heavy scrutiny.”