Another N.C. county reverses fluoride in water practice, raising concerns for others

Last month, a second North Carolina county voted to stop adding fluoride, a naturally occurring mineral used to strengthen dental health, from its water supplies. 

Lincoln County's decision comes the same week as Robert F. Kennedy Jr., a longtime community water fluoridation skeptic, was confirmed as secretary of the U.S. Department of Health and Human Services. 

During his confirmation hearing, Kennedy reiterated his view against community water fluoridation after questioning from U.S. Sen. Thom Tillis (NC-13). Kennedy cited a January Journal of American Medical Association Pediatrics review of 74 studies performed outside of the United States that found a positive correlation between decreased IQ levels in children and increased fluoride exposure. 

Dental Public Health Specialist Rhonda Stephens said the discovery that adding small amounts of fluoride to public water supplies reduces tooth decay came in the 1940s.

Following its success in Grand Rapids, Mich. — the first community to add fluoride to its water supply in 1945 — water fluoridation spread across the country and is now common practice.  Since its addition, Stephens said there has been an average of a 25 percent reduction in tooth decay rates in populations that have access to fluoridated water.

According to United Health Foundation data from 2022, 88 percent of North Carolina's population is served by fluoridated community water systems, compared to 72.3 percent of the U.S. population on community water systems as reported by the The U.S. Centers for Disease Control and Prevention. The CDC named community water fluoridation one of the Ten Great Public Health Achievements of the 20th century. 

Stephens said the studies that found a link between IQ and fluoride exposure were performed in countries that provide fluoride at rates four to five times higher than what is provided in the United States. 

“There is a limit to even sodium,” Stephens said. “You need sodium in your diet, but if you have an excessive amount of sodium, you have a health issue. Fluoride is the same way.”

Steve Cline, vice president of the North Carolina Oral Health Collaborative, said having small amounts of fluoride in water is particularly important for underserved communities who already have difficulty accessing dental care. 

Much of the population who believes in the positive benefits of fluoride can ask their dentist or pediatrician to provide the fluoride for them or they can supplement it on their own, Cline said. 

“It's not as easy and not as convenient as having it in the water system, but they can,” he said. “They have a way of getting that many of the underserved populations, particularly in rural areas, don't have the same access to.” 

Union County became the first North Carolina county to prohibit the addition of fluoride to its public water in Feb. 2024.

Union County Board of County Commissioners Vice Chair Brian Helms said the issue was brought forward by Union County residents concerned about adverse effects of water fluoridation.

He said the decision came after a year-long process involving multiple public hearings and expert testimonies, where the board ultimately decided to listen to their constituents. Helms said his decision was motivated by wanting to give the decision over receiving fluoride treatment to citizens instead of the county government. 

“The fluoride in your drinking water is the one and only chemical that we actually put into the drinking water that is meant to treat the person and not the water,” Helms said. “For me, at least in my vote, there was certainly an issue with consent. I personally struggle with the fact that I don't believe that a board of county commissioners has the authority to medically treat the individual.” 

The debate over community water fluoridation has continued to expand across the state, with Stanly County currently reconsidering it.

Cline said oral disease rates have gone up in communities in different areas of the country where fluoride was taken out of water after having been present previously.

“I am concerned that what we worked to remedy 80 years ago in terms of tooth decay, we will see a resurgence of in those high rates of something that is largely preventable, just like we're seeing now with measles,” Stephens said.

Stephens said this topic has always been contentious, but the federal spotlight raises the likelihood that resistance to community water fluoridation will grow. 

“It still ultimately is the decision of a local community whether they want to keep or implement it, but the concern is making sure they have the correct information, because what's coming down largely is misinformation,” Stephens said.

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