Governor Spencer Cox signed legislation on March 27 making Utah the first state in the U.S. to ban the addition of fluoride to public drinking water systems. The new law, which takes effect on May 7, 2025, overrides local decisions on water fluoridation and marks a significant shift in public health policy.
The ban comes amid renewed scrutiny of water fluoridation, a practice that has been implemented across the United States since 1945 to prevent dental cavities. Utah previously ranked 44th nationally for the percentage of residents receiving fluoridated water, with only 66 out of 484 water systems adding the mineral.
Legislative Support and Opposition
Republican lawmakers, including state Representative Stephanie Gricius and Senator Kirk Cullimore, championed the bill, arguing that adding fluoride to public water is too expensive and infringes on individual choice.
"I don't dispute that there can be positive benefits from fluoride, which is why the bill also includes a deregulation of the prescription," Gricius stated. "This isn't anti-fluoride legislation, it is pro-informed consent and individual choice."
The legislation does not specifically cite health concerns as justification for the ban. Governor Cox has previously claimed that oral health outcomes between fluoridated and non-fluoridated communities in Utah showed no significant differences, though this assertion contradicts published research.
Dental Experts Express Concern
Dental professionals and public health experts have voiced strong opposition to the ban, warning that it could lead to increased cavity rates, particularly in underserved communities.
"Fluoridation is the most cost-effective way to prevent tooth decay on a large scale," said Lorna Koci, chair of the Utah Oral Health Coalition.
Val Radmall, executive director of the Utah Dental Association, reported meeting with Representative Gricius to discuss reconsidering the bill. Drawing from his 30 years of practice in a non-fluoridated community, Radmall observed: "I'd have a patient come in without cavities or anything else like that, and I'd say, 'You didn't grow up here. Where did you grow up?' ... because everybody here has lots of cavities!"
Scientific Evidence on Fluoridation
The scientific consensus supports water fluoridation as an effective public health measure. A systematic review of 20 studies published in 2007 found a 27 percent reduction in cavities among adults in fluoridated communities. Similarly, a 2018 study demonstrated a 30 percent reduction in cavities among children with access to fluoridated water.
Dr. Scott Tomar, a public health dentist and oral epidemiologist at the University of Illinois Chicago, emphasized that the benefits of community water fluoridation are most pronounced in low-income communities—"communities that often have the least access to dental care and to other sources of fluoride."
Safety Concerns and Recent Research
Recent debates about fluoride safety have centered on potential cognitive effects in children. A recent review of studies suggested a possible link between high levels of prenatal or childhood fluoride exposure and lower IQ scores. However, Dr. Tomar noted that the fluoride levels associated with these cognitive concerns are approximately twice as high as those typically used in community water fluoridation programs.
Political Context
The Utah ban coincides with the appointment of Robert F. Kennedy Jr. as federal health secretary, who has expressed skepticism about water fluoridation despite its recognition as one of the greatest public health achievements of the 20th century.
"I think the anti-fluoride people, they're latching onto Kennedy's opportunity with his beliefs and using that now as a way to kind of get in the door to stop water fluoridation," observed Koci.
Local Precedent
The statewide ban overturns local community decisions, including that of Brigham City, where voters rejected a proposal to remove fluoride from their water supply by more than a 2-to-1 margin in 2023. Salt Lake City, Utah's capital and largest metropolitan area, was among the 66 water systems that had previously added fluoride.
Public health experts worry that Utah's decision could inspire similar legislation in other states, potentially leading to a nationwide increase in oral health problems, particularly among vulnerable populations who lack access to alternative fluoride sources and regular dental care.
