Showing Teeth

Start with what is not in dispute. The Centers for Disease Control and Prevention lists community water fluoridation among the ten great public-health achievements of the twentieth century, and the CDC, the American Dental Association, and the World Health Organization hold that fluoride at the level American systems use — 0.7 milligrams per liter — is safe and prevents tooth decay.

What is contested is what happens at higher doses. A 2024 National Toxicology Program review concluded, with moderate confidence, that fluoride above about 1.5 mg/L — roughly double the U.S. target, and common in naturally high-fluoride water abroad — is associated with lower IQ in children. A 2025 meta-analysis in JAMA Pediatrics reported associations reaching lower levels, but it leaned heavily on high-risk-of-bias studies from high-fluoride regions and drew sharp methodological criticism, and the Environmental Protection Agency is still reviewing the question. None of that is the same as evidence that 0.7 mg/L harms the children who drink it, and 0.7 mg/L is the level Pasco was arguing about.

The cost of guessing wrong is countable. A modeling study cited by the CareQuest Institute estimates that ending fluoridation across U.S. water systems would mean about ~25.4 million additional decayed teeth and ~$9.8 billion in added costs over five years, concentrated among low-income and uninsured children — the families least able to make up the difference in a dentist's chair.

Pasco did not hide the ball. Over the summer of 2025 the council held listening sessions, ran a multilingual survey, and sat through a June 16 hearing that lasted two hours. The dentists came on both sides. Bill Osmunson — a Fluoride Action Network senior advisor, retired after almost five decades in dentistry and a master's in public health — told the council he had promoted water fluoridation for his first 25 years in practice and spent the last two decades “highly opposed.” Spencer Jilek, who has practiced in Pasco for 42 years, spoke against pulling it. Rebecca Francik — a former Pasco City Council member and Mayor Pro-Tem who addressed the council as a former educator — remembered the years before the schools had fluoridated water, when children turned up at the nurse with “little rotted-off teeth.”

On the dais, the argument was about the science and the mail. Council Member Charles Grimm pointed to a January meta-analysis in JAMA of 59 studies on fluoride and childhood IQ. Another member said he had doorbelled 800 homes and heard, somewhere between Costco and speeding and homelessness, that his district wanted fluoride out. When the vote came on November 17, the council split 4–2 — Milne, Grimm, Cotta, and Perales to stop it; Barajas and Blasdel to keep it. The city notified the state the next day, and fluoride left the water on February 10, 2026.

Not everyone took the vote quietly.

Pasco is not alone, and the reasons its neighbors give are not all the same. Since a 2024 federal court ruling ordered the EPA to act on fluoride, dozens of communities have stopped — the Fluoride Action Network counts more than 75, serving some ~30 million people — and Utah and Florida have banned it statewide. The push has a national face: Health and Human Services Secretary Robert F. Kennedy Jr. has pressed the CDC to stop recommending fluoridation at all.

But the same decision keeps arriving in different clothes. In Pasco, the council argued it openly as health and politics, and cost never entered. In Camden, Indiana, the town council folded its March vote to discontinue into a discussion of equipment-replacement costs. In Madison, Alabama, the utilities board ended fluoridation unanimously and pointed at its treatment plant, where it said the acid had rusted pipes and ceiling panels and damaged the concrete of its Keene facility — and drew criticism that residents were never asked. In Weddington, North Carolina, the council took up removal and declined.

Some of the retreat has nothing to do with any of that. A war-driven shortage of hydrofluorosilicic acid — an Israeli producer went dark during the Iran–Israel conflict — has forced utilities to cut back regardless of what they think about fluoride. Baltimore dropped its level from 0.7 to 0.4 milligrams per liter; Lewiston-Auburn, Maine, stopped. The acid keeps about a month, so no one can stockpile through a bad year. The test for any one town is whether its stated reason survives its own record: a plant that is genuinely corroding is a different story from a plant that is not.

The bill for these decisions does not fall evenly. Fluoridated water is the rare dental benefit that reaches a child whether or not the family ever sees a dentist. Take it out, and the protection that remains is the protection a household can buy. That is why the modeled costs land where they do — on the children Rebecca Francik was describing, the ones who used to show up at the nurse's office.

Pasco heard all of it and voted anyway, 4–2, with a survey and two hours of testimony behind it. That is what makes the retreat hard to fault as a matter of process and easy to question as a matter of consequence. The water is a public thing. So are the teeth.