Water fluoridation was controversial in New Jersey long before Robert F. Kennedy Jr. said if given the power he would take steps to strip it from public water.
New Jersey has a reputation for being at the forefront of public health initiatives, but it’s behind when it comes to endorsing the long-standing public health practice of community water fluoridation. In fact, New Jersey has the second lowest fluoridation rate in America, ranking 49 out of 50 states, behind Hawaii, according to the latest rankings.
Only 16% of the state’s population has access to water fluoridated at the federally recommended levels, significantly below the national average of 73%, according to America’s Health Rankings from the United Health Foundation.
Of the half dozen dental professional and public policy experts interviewed by NJ Advance Media, none could say exactly why water fluoridation has never taken off in New Jersey.
But it’s not for a lack of trying.
Since 2005, and as recently as this January, legislators have introduced bills that would require public water systems to be fluoridated, but it’s never been voted on by the full Legislature. The decision to add it to the water is often handled on the local level.
“We’ve written letters to the state legislature each time it comes up, but it never gets done,” said Kenneth Markowitz, an associate professor at Rutgers School of Dental Medicine and a practicing dentist of almost 40 years.
The U.S. Centers for Disease Control and Prevention said drinking water with the proper level of flouride — estimated to be 0.7 milligrams per liter — will reduce 25% of dental cavities over a person’s lifetime, and it’s been used as a public health tool since the 1900s.
While it has been widely adopted throughout the U.S. — some states, such as California, have laws that require it be added to water systems of a certain size — it’s also periodically gotten pushback. Critics say it’s less necessary in an age of fluoride-containing toothpaste and other dental products and could cause dental damage in high doses.
Kennedy, who could become the next secretary of the Department of Health and Human Services under President-elect Donald Trump, recently described it as “an industrial waste associated with arthritis, bone fractures, bone cancer, IQ loss, neurodevelopmental disorders, and thyroid disease.”
It’s a comment many medical experts have pushed back on and scientific studies have refuted.
The New Jersey Dental Association, the New Jersey Academy of General Dentistry, and the Rutgers School of Dental Medicine all support water fluoridation at the recommended levels as a community health measure. It’s also supported by the American Dental Association and World Health Organization.
“Decades of studies and scientists’ science — versus RFK science — demonstrate the oral health benefits of safe levels of fluoridation in water. I’m sponsoring the bill simply to protect against tooth decay and prevent cavities,” aid State Sen. Raj Mukherji, D-Hudson, one of the recent bill sponsors.
Despite scientific evidence of its efficacy, fluoridated water still faces skepticism from advocates for holistic medicine and groups like the Fluoride Action Network, which argues that it’s toxic.
A 2018 Fairleigh Dickinson University poll found that nationwide, 43% believe fluoridated public drinking water is a way for chemical companies to offload dangerous toxins into the environment. The same survey also asked questions about trust in local and state government and found that those who trust government the least are also the least likely to believe in the benefits of fluoridated drinking water.
In the years since that study was conducted, overall trust in government has declined, said Dan Cassino, a political science professor at Fairleigh Dickinson University and director of FDU Poll.
“We’ve also seen more people say that they want to do their own research. The ADA (American Dental Association) says it’s a good thing, the CDC says it’s good, but there’s this study that says fluoride decreases IQ, so people come to their own conclusions,” Cassino said.
A report released in August by the National Toxicology Program, which is part of the National Institutes of Health, concluded with “moderate confidence” that there is an association between higher levels of fluoride and lower IQ in children. However, the study examined fluoride at levels of 1.5 milligrams per liter or more — twice as high as what’s added to public water.
“Everything is toxic in sufficiently large doses,” said Cassino.
While studies have concluded that too much fluoride can lead to dental issues, such as discoloration, fluoride at recommended levels is safe, according to the U.S. Department of Health and Human Services.
“Misinformation linking fluoride to severe health risks, such as cancer or neurological issues, often involves exposure far beyond levels used in water fluoridation,” said Orville Morales, director of advocacy and health affairs for the New Jersey Dental Association. “Ultimately, fluoride is like salt. A small amount can enhance a dish significantly. Too much salt can lead to heart disease.”
“Fundamentally this is a miseducation issue,” said Morales.
In New Jersey, it’s also a home-rule issue.
“We consider the fluoridation of drinking water supplies to be a community-based decision,” New Jersey American Water says on its website. “This means that any system in which we currently fluoridate, the decision to initiate fluoridation was not made by the company.”
Customers served by New Jersey American Water where fluoride is added in the drinking water include more than three dozen towns in Monmouth and Ocean counties, as well as Jamesburg Township in Middlesex County. Fluoridation has been temporarily suspended at the Raritan-Millstone Water Treatment Plant — which serves nearly two dozen towns in Somerset, Middlesex, and Mercer counties — due to ongoing water treatment plant upgrades, but fluoridation is expected to resume upon completion, according to the company’s website.
In response to recent debate around fluoride, the Academy of General Dentistry released a statement reiterating its support for water fluoridation as the most cost-effective way to prevent cavities and tooth decay.
“I think it’s a good thing for folks to do their own research, but just like anything else, we’ve got to be mindful of the websites and sources we’re using,” said Vice President George Schmidt, who owns a private dental practice in New Jersey.
“There are some studies out there that show adverse reactions but many of those are at higher levels than we advocate. We believe that when it comes to fluoride at the recommended levels, the benefits far outweigh the risks,” said Schmidt.
New Jersey residents without access to fluoridated water can still take steps to incorporate fluoride into their routine. Dentists encourage patients to add fluoride tablets to their own water, use fluoridated toothpaste, and exercise good oral hygiene by brushing twice a day and flossing.
Residents can also check if their respective community adds fluoride to the water at the Department of Environmental Protection’s website, which lists public community water systems that may contain fluoride.
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Jackie Roman may be reached at jroman@njadvancemedia.com.
