Tallahassee, Fla.—Today, State Surgeon General Dr. Joseph A. Ladapo announced guidance recommending against community water fluoridation due to the neuropsychiatric risk associated with fluoride exposure. 

Fluoride is a naturally occurring chemical compound present in groundwater, fresh and salt water, rainwater, soil, plants, and foods. Community water fluoridation is the process of adjusting the amount of fluoride in drinking water to a level recommended to prevent tooth decay. Historically, community water fluoridation was considered to be a method to systemically, through ingestion, deliver fluoride to all community members. However, currently many municipalities across the U.S. and several European countries, including Austria, Belgium, France, Germany, Italy, Norway, and Sweden, have eliminated water fluoridation.   

Today, fluoride is widely available from multiple sources, including topical fluorides, such as toothpaste, mouthwashes, and fluoride applications by dental providers. Evidence shows fluoride strengthens teeth, making them more decay resistant. However, additional research is being conducted to review the impacts of overall fluoride exposure in the population. 

Floridians should be aware of safety concerns related to systemic fluoride exposure including:  

• Adverse effects in children reducing IQ, cognitive impairment, and attention deficit hyperactivity disorder. 

• Increased neurobehavioral problems in children whose mothers ingested fluoride during pregnancy. 

• Accumulation of fluoride in the pineal gland, causing sleep cycle disturbance.  

• Skeletal fluorosis, which could increase the risk of bone fracture. 

• Potential risk of premature menarche in adolescent girls. 

• Potential suppression of the thyroid gland by inhibiting iodine absorption. 

Due to the neuropsychiatric risk associated with fluoride exposure, particularly in pregnant women and children, and the wide availability of alternative sources of fluoride for dental health, the State Surgeon General recommends against community water fluoridation. 

The Florida Department of Health strongly supports oral and overall health through: 

• Operation and expansion of school-based preventive dental services. 

• County health department dental clinics, which provide dental services to communities. 

• Screening and treatment referral in pre-school and school settings. 

• Provider education, including training on oral health service delivery for those with special health care needs. 

• Promotion of healthy habits, with emphasis on a reduction in sugar consumption, through oral health education to communities.  

• Providing oral health care supplies to community partners. 

• Providing tobacco and vaping cessation resources and services. 

“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, it is estimated that more than 70% of Floridians on community water systems receive fluoridated water. To see if your community water system is included, please visit the Florida Department of Health's  Public Water Systems Actively Fluoridating webpage.

About the Florida Department of Health

The Florida Department of Health, nationally accredited by the  Public Health Accreditation Board, works to protect, promote and improve the health of all people in Florida through integrated state, county and community efforts.