The Florida Department of Health has issued new guidance on community water fluoridation, with State Surgeon General Dr. Joseph A. Ladapo recommending against the practice due to concerns over systemic fluoride exposure.
Fluoride occurs naturally in groundwater, fresh and salt water, rainwater, soil, plants, and foods. Community water fluoridation involves adjusting fluoride levels in drinking water to prevent tooth decay. Historically, this method was used to deliver fluoride systemically to all members of a community. However, many municipalities in the United States and several European countries—such as Austria, Belgium, France, Germany, Italy, Norway, and Sweden—have discontinued water fluoridation.
Today, fluoride is accessible from various sources including toothpaste, mouthwashes, and dental treatments. Evidence supports that fluoride strengthens teeth and helps resist decay. Despite this benefit, research continues into the effects of overall fluoride exposure among populations.
According to the department’s statement, Floridians should be aware of safety concerns linked to systemic fluoride exposure. These include adverse effects in children such as reduced IQ and cognitive impairment; increased neurobehavioral problems in children whose mothers consumed fluoride during pregnancy; accumulation of fluoride in the pineal gland potentially disturbing sleep cycles; skeletal fluorosis which may raise bone fracture risk; possible early onset of menstruation in adolescent girls; and potential thyroid suppression by inhibiting iodine absorption.
Citing these risks—particularly for pregnant women and children—and noting the wide availability of alternative topical sources for dental health needs like toothpaste or professional applications—the State Surgeon General now recommends against community water fluoridation.
The department remains committed to promoting oral health through other initiatives: expanding school-based preventive dental services; operating county health department dental clinics; providing screenings and referrals in schools; educating providers on serving those with special health care needs; encouraging healthy habits including reducing sugar intake through community education programs; supplying oral health care products to partners; and offering tobacco and vaping cessation resources.
“It is clear more research is necessary to address safety and efficacy concerns regarding community water fluoridation,” said State Surgeon General Dr. Joseph A. Ladapo. “The previously considered benefit of community water fluoridation does not outweigh the current known risks, especially for special populations like pregnant women and children.”
Based on self-reported data from 2023, more than 70% of Floridians who use community water systems receive fluoridated water. Residents can check if their local system adds fluoride by visiting the Florida Department of Health's Public Water Systems Actively Fluoridating webpage (https://www.floridahealth.gov/environmental-health/drinking-water/fluoridation/index.html).
The Florida Department of Health is nationally accredited by the Public Health Accreditation Board (https://phaboard.org/) and works statewide through integrated efforts at state, county, and community levels.