The US $10 billion dental disaster: What happens if we stop fluorinating water?

Eliminating U.S. public water supply systems from the U.S. will cause a nearly $10 billion dental health crisis, according to the economic consequences of proposed policy changes.

The study, published in the JAMA Health forum, predicts that tooth decay will increase by 7.5 percentage points in children if the fluorination program ends nationwide.

Using data from more than 8,400 children tracked by the federal health survey, the researchers created a complex computer model to predict what would have happened if the United States abandoned public health practices that began in 1945. The results depict a distinctive picture of poor oral health and soaring treatment costs.

The hidden costs of policy changes

Analysis shows that removing fluoride will increase attenuated teeth by 25.4 million in five years, with treatment costs reaching $9.8 billion. These figures reflect only direct medical expenses – the real social costs will be much higher when considering missed work and school days.

What makes these predictions particularly concerned is how burdens will create a disproportionate burden on vulnerable populations. Children with public insurance or no insurance have the heaviest impact, complicating existing health differences in dental care.

Currently, 40.4% of U.S. children can obtain the best fluoride levels in their drinking water, while 45.7% of children get less than the best content. The remaining children are either completely deficient in fluorinated water or are exposed to excessive levels that can lead to fluorination in rare cases.

The story of two scenes

A research team led by scientists at Harvard Medical School examined a variety of situations using data from the National Health and Nutrition Examination Survey. Their microsimulation model tracks 10,000 virtual children from birth to 19 years of age, involving factors such as family income, insurance status and geographical location.

In the most dramatic situation, the prevalence of eliminating fluoride-caries from all water supply systems will jump significantly across all age groups. Children aged 2 to 5 will increase the attenuation rate from the baseline of 21.3% to nearly 29%. For teenagers aged 13 to 19, interest rates will rise from 57.2% to over 64%.

The study also establishes the opposite situation: optimizing fluoride levels in all current fluorinated regions. This approach will prevent 22 million teeth from rotting and save $9.3 billion over five years, indicating the potential benefits of improving rather than abandoning the fluorination program.

Fairness Question

Perhaps the most disturbing findings involve how fluoride removal worsens existing health disparities. The researchers found that open and uninsured children experience the biggest increase in tooth decay, which is the population already struggling with limited dental care.

This difference exists because fluorinated water acts as a preventive measure for people who do not depend on personal behavior or health care visits. When this protection disappears, children without routine dental care suffer the most.

Key research results:

• All children’s dental caries will increase by 7.5 percentage points
• 25.4 million rotting teeth will occur within five years
• Healthcare costs will increase by $9.8 billion over the same period
• Children with open insurance will face the heaviest burden
• The effect will worsen over time, reaching $19.4 billion in 10 years

Beyond simple cost calculations

The research’s approach reveals important nuances often missing in policy debates. The researchers calibrated the real-life data from the federal health survey to ensure their predictions reflect actual patterns of dental disease in different populations.

Importantly, the analysis focused only on children and ruled out potential adult welfare to adopt a conservative approach. It also doesn’t say the “halo effect” that even communities with suboptimal fluoride levels may still gain some protective benefits.

The researchers conducted extensive sensitivity analysis to test their hypotheses. Even if they believe fluoride has an effective effect of preventing attenuation (less than 25% used in their main models) of only 7.5%, fluoride fluoride will still cost $2.08 billion and lead to substantial health losses.

Neurotoxicity debate

The study deliberately avoids modeling the potential cognitive effects of fluoride exposure and points to ongoing scientific uncertainty. Although some studies link high fluoride levels to lower IQ scores, current evidence does not support the neurocognitive effects of concentrations used in public water supply systems.

The researchers acknowledge this limitation, but point out that current federal guidance from the CDC and the National Toxicology Program did not find harmful neurobehavioral effects at recommended fluorination levels. Using environmental protection mechanism thresholds, the public water supply system is safely fluorinated 99.99% of the time.

This approach reflects the challenge facing policy makers: scientifically unproven theoretical risks balance established dental health benefits at current levels of exposure.

Real-world evidence

Modeling results are consistent with real-world experiences. Calgary, Alberta, removed fluoride from water supply in 2011 and reintroduced fluoride in March 2025 until an increase in increased dental disease in children was observed. This natural experiment verifies concerns about the consequences of abandoning fluorination.

The study also highlights an important fairness consideration: While wealthy families can compensate for lost fluorination through private dental care and topical treatment, low-income families often cannot. This means that seemingly neutral policy changes will actually worsen health disparities.

Policy Impact

As political discussions on fluoride intensify, the study provides specific data on the potential consequences of policy changes. The $9.8 billion price represents only health care costs, including the wider economic impact of loss of productivity and education disruptions will be significantly higher.

The study suggests that policy makers may consider optimizing current plans rather than eliminating fluorination. Raising all fluorinated areas to optimal levels prevents millions of cavity while maintaining safety standards.

For families focusing on fluoride exposure, the study highlights the importance of considering population-level effects. Individual choices regarding fluoride use occur in a wider public health environment where community-wide protection measures for expelled community-wide harm disproportionately harm vulnerable children.

Clear charts generated from this analysis: Fluorinated water remains one of the most cost-effective interventions for public health, with evacuation far exceeding the various households and affecting the entire community and health care system nationwide.